Merchant Registration Form
Please complete all fields to ensure that there is no delay to your application. If you have any questions do not hesitate to contact us
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Company Information
Basic Information
Let’s start with some basics
Company Name
Company Type
Website Address
Main Telephone
Incorporation Number
Date of Incorporation
Industry
VAT/Tax Number
Registered Office Address
Operating Office Address
Main Contact
Bank Details
Shareholders
Authorised Users
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PROCESSING
3
INTEGRATION
4
DECLARATION
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2
3
4
Company Information
Basic InformationRegistered AddressMain ContactBank DetailsShareholdersAuthorised Users
Previous
Next
Let’s start with some basics
Company Name
Company Type
Website Address
Main Telephone
Incorporation Number
Date of Incorporation
Industry
VAT/Tax Number
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2
3
4
Company Information
Registered Office Address
Operating Office Address (if different)
Main Contact
Bank Details
Shareholders
Authorised Users
PROCESSING
URLs
Information
Integration
Contact
Type
Declaration
Let’s start with some basics
Company Name
Company Type
Website Address
Main Telephone
Incorporation Number
Date of Incorporation
Industry
VAT/Tax Number
1
2
3
4
Company Information
Registered Office Address
Operating Office Address (if different)
Main Contact
Bank Details
Shareholders
Authorised Users
PROCESSING
URLs
Information
Integration
Contact
Type
Declaration
Add Bank Details
Use the + button to add a new currency account (max 3). If needed, supply additional currency accounts on company letterhead signed by a Director.
Account Currency 1
Name of Account Holder
Bank Name
Country of Account
Account Number or IBAN
BIC or Sort Code
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2
3
4
Company Information
Registered Office Address
Operating Office Address (if different)
Main Contact
Bank Details
Shareholders
Authorised Users
PROCESSING
URLs
Information
Integration
Contact
Type
Declaration
Processing URLs
Use the + button to add a new URL
URL
Descriptor
Test User ID
Test Password
MCC
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Company Information
PROCESSING
URLs
Information
Integration
Declaration
Processing Information
Processing Currency
- EUR
- GBP
- USD
- CAD
- AUD
- Other
Settlement Currency
- EUR
- GBP
- USD
- CAD
- AUD
- Other
Cards you wish to accept
- Visa
- Master Card
- AMEX
- Union
- JCB
- Other
Current Acquiring Bank
Lenght of time with Acquirer
Reason for leaving
- I own the product/inventory
- I use Service / Product Suppliers
- I fullfil orders directly
If you’ve ever had a processing relationship terminated – please comment on the reasons
Enter reasons here
Average Transaction Value
High Volume Months
Chargeback to Sale Ratio
Amount Processed /Month
No of Chargebacks /Month
Refunds to Sale Ratio
No of Transactions /Month
No of Refunds /Month
Business Cards Turnover (%)
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4
Company Information
PROCESSING
Integration
Contact
Type
Declaration
Integration Contact
The person completing this application and liaising with the Quaife.net integration team
First Name
Last Name
Job Title
Work Email Address
Work Telephone Number
Mobile/Cell Phone Number
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4
Company Information
PROCESSING
Integration
Declaration
Declaration
We declare that the information supplied is correct and accurate to the best of our knowledge and we have read and agree to your Terms and Conditions. We require a board member signature. That can be yourself and one Director if you are not on the Board of Directors.
MAIN CONTACT SIGNATURE
Signed
Name
Official company Position
Date
If you, as the main contact, are not on the Board of Directors, then we require one other signature from a Board Director.
BOARD DIRECTOR