Contact Information

Contact Name:

Contact Phone Number:

Contact Email Address:

Domain name to be used for Merchant Account:
eg. www.mydomain.com (enter "none" if you do not have one)

Business Information

Company Name:

Company address:

Type of business:

Nature of business:

Please give a brief description of what your company does:

How long have you been trading:

Annual turnover in pounds sterling as per last years financial accounts:

Estimation of this current financial years turnover to be:

What percentage of your turnover do you expect to be processed through your merchant account facility?(If you have not commenced trading yet please give an estimate) %

Who does your business currently bank with?

Do you currently have a merchant account with the bank you selected above. (i.e. take credit cards through a card terminal or swipe box ?) Yes No

Preferences

Is there a particular bank you would like to use to process your application with?

Please state any associations you are a member of and include your membership number
(Members of Trade Associations such as the FSB may qualify for reduced setup and processing rates with the acquiring banks)

Please select which currencies you wish to trade in, pound sterling must be one of them ?

Australian Dollar
Canadian Dollar
Danish Krone
Euro
Hong Kong Dollar
Israeli Shekel
Japanese Yen
Korean Won
Norwegian Krone
Saudi Arabian Ryal
Swedish Krone
Swiss Franc
UK Pounds
US Dollars
If others, please specify:

How soon do you want to get an Ecom Merchant service up and running so you can accept credit card payments through your web site ?

Are you interested in the six months free Web hosting offer?

If you are going to be using a Shopping Cart please state which one (Click here for currently supported shopping carts)

Where did you hear about us ?

Payment Solutions Application Form

Contact Information

Business Information

Preferences