Business Entity:
Sole trader Registered business
Date of incorporation:
(mm/dd/yyyy)
Business License Number:
Current/Previous Processor:
None Yes,
Maximum monthly Chargebacks with previous processor:
Reason for changing processors:
Company Name/DBA Name:
Legal business name, for sole traders this will always be the name of the contract holder.
Owner/CEO:
The registered owner of the registered company or the name of the sole trader.
Business Address:
Registered address of the company or home address of sole trader.
State/Province/County:
Zipcode/Postcode:
City:
City where the business is registered or where sole trader lives.
Country:
Country where the business is registered or the sole trader's permanent country of residence. If your country is not listed, please select Other.
Select your country:
Other
Albania
Algeria
American Samoa
Andorra
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Aruba
Australia
Austria
Bahamas
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Cook Islands
Costa Rica
Croatia (Hrvatska)
Cuba
Cyprus
Czech Republic
Czechoslovakia (former)
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Estonia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Georgia
Germany
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea Bissau
Guyana
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kenya
Kiribati
Korea (South)
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
Neutral Zone
New Caledonia
New Zealand
Nicaragua
Niger
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Seychelles
Singapore
Slovak Republic
Slovenia
Solomon Islands
South Africa
South Georgia and South Sandwich Isls.
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Vanuatu
Vatican City State (Holy See)
Venezuela
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna Islands
Western Sahara
Yemen
Phone Number:
Telephone number of the registered business or sole trader.
Fax Number:
Fax number of registered business or sole trader, if applicable.
Account E-mail Address:
Please provide business email address, no FREE email addresses!
URL(s) of your website(s):
Please list all URL's you wish to use for processing.
Hosting Company:
Please list the hosting company of your website.
Type of business:
Please categorize your business:
Adult
Adult DVD-video-toys
Dating
Gaming-Gambling
Herbal Pharmacy
Mainstream
Pharmacy
Software
Travel
VoiP
Other
Short description of business:
Please provide short but clear description of your business.
Transaction currency:
Please provide the currency of your choice for accepting payments.
US Dollars
Great British Pounds
Euro
Australian Dollar
Other
Lowest price per item:
Please list the price of the cheapest item you offer on the website.
Highest price per item:
Please list the price of the most expensive item you offer on your website.
Settlement currency:
Please provide the currency of your choice for settlements to your account. (USD, GBP or EUR)
Select currency:
US Dollars
Great British Pounds
Euro
Expected sales amount per month:
Bank account beneficiary name:
The name of your bank:
The location of your bank:
How did you find us? Select:
Select below...
searchengine
web or magazine advertising
recommendation
taxi-trip.com
OCH ltd.
other
Your E-Mail Address:
Write your message/questions here: