Payment Solutions Application Form

Not only do you benefit from the lowest ecommerce transaction charges on the market, but we will also host your ecommerce web site free of charge for six months on our corporate hosting platform (either Linux or Windows)

The corporate hosting package has a whole host of features, 10Gb of Web Space, Unlimited Mailboxes, 10 Mysql Databases, PHP, PERL, CGI, SSI, Python, ASP, Daily Web Stats and more.

Each EcomMerchant Applicant will be offered a six month free hosting account in anticipation of obtaining an Internet Merchant Account (IMA). After the free period ends normal hosting charges will apply or should you not manage to obtain an IMA then you can of course choose to pay for the hosting account as normal.

Contact Information

Contact Name:

Primary Contact Phone Number:

Secondary 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:

Country Business Operates In:

Please give a brief description of what your company does:

How long have you been trading:

Annual Card turnover in GBP (Sterling) as per last years financial accounts (if you have not commenced trading yet please put in 0) £

Estimated/Actual Card Turnover in GBP (Sterling) for the current financial year (If you have not commenced trading yet please give an estimate) £

What is the average individual transaction value you expect to put through on cards (Credit and Debit) £

Who does your business currently bank with?

Have you applied to any acquiring banks for an Internet Merchant Account (IMA) already? Yes No

Preferences

Which product would you like to apply for? ECOM MOTO TERMINAL

Is there a particular acquiring bank you would like to use to process your merchant account 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 ?

Promo Code (If you have been given a promo code by an existing customer please enter it in the box provided to earn credit on your account once live)

* Make your turnover and average transaction as accurate as possible as this can affect your application

Minimum 12 Month Contract applies to all ECOM/MOTO services. Early termination fee may apply. Full Terms & Conditions can be found on our website under the 'About Us' section