Business Merchant Application

Basic Information

Lead Source:

Select the region:

Application Date:

Application IP:

Company Name:

Payments Type:

Application Type:

Business (KYB) Details

Legal Business Name:

DBA (Doing Business As):

Business Address:

City:

State:

ZIP:

Country:

Business Phone:

Website URL:

Corporate Type:

TIN / EIN:

Representative (KYC) Details

First Name:

Last Name:

Role/Relationship:

Mobile Number:

Email Address:

SSN / Passport ID:

Banking / Payout Information

Bank Name:

Bank Account #:

Routing / SWIFT / IBAN:

Account Holder Name:

Account Type:

Business (KYB) Details (cont.)

Corporate Type:

Industry/MCC Code:

Country of Incorporation:

Date of Incorporation:

Company Registration Number:

Ownership Structure:

Driver Licence Number:

Representative (KYC) Details (cont.)

Principal Address:

Date of Birth:

Home Address:

City:

State:

ZIP:

Country:

Ownership %:

Principal Title:

Processing Details

Projected Monthly Volume:

Current Monthly Volume:

Currency:

Processing Type: