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Application Form – Corporate Merchant

This Application Form is for Companies Only. If you are an individual, please apply by downloading the App from Google Play Store HERE

*All the fields marked with an asterisk (*) are required to complete the form.

Company Details

Company Name*

Company Registration Number*

Company Registered Address*

Registration Doc* (Max 1MB)

Company Trading Address*

Utility/Rent Invoice* (Max 1MB)

Company VAT Number*

VAT Certificate* (Max 1MB)

Company Bank Details*

Bank Letter* (Max 1MB)

Type of Business (Products Sold)*

Other Businesses

Company Website

Number of Stores/Outlets

Annual Turnover*

Company Phone Number*

Company Email Address*

Contact Details

First Name*

Last Name*

Contact Cell Phone Number*

Contact Email Address*

Directors' Details

Directors' Name*

This Director is also a Shareholder

ID/Passport* (Max 1MB)

Directors' Address*

Utility Invoice* (Max 1MB)

Directors' Name

This Director is also a Shareholder

ID/Passport (Max 1MB)

Directors' Address

Utility Invoice (Max 1MB)

Directors' Name

This Director is also a Shareholder

ID/Passport (Max 1MB)

Directors' Address

Utility Invoice (Max 1MB)

Directors' Name

This Director is also a Shareholder

ID/Passport (Max 1MB)

Directors' Address

Utility Invoice (Max 1MB)

Shareholders' Details >20%

Shareholders' Name

ID/Passport (Max 1MB)

Shareholders' Address

Utility Invoice (Max 1MB)

Shareholders' Name

ID/Passport (Max 1MB)

Shareholders' Address

Utility Invoice (Max 1MB)

Shareholders' Name

ID/Passport (Max 1MB)

Shareholders' Address

Utility Invoice (Max 1MB)

Shareholders' Name

ID/Passport (Max 1MB)

Shareholders' Address

Utility Invoice (Max 1MB)

Other Beneficial Owners

Name

ID/Passport (Max 1MB)

Address

Utility Invoice (Max 1MB)

Name

ID/Passport (Max 1MB)

Address

Utility Invoice (Max 1MB)

I confirm that I have read and agree to the terms and conditions View Merchant T&C's and may bind the company contractually

I confirm that I have authority to act on the company's behalf with regards to agreeing to the Merchant T&C's and may bind the company contractually