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Shop
Help
Appointment
Applicaiton Form
+44 (0) 161 615 4662
Sign in
Get Started
Application Form
Company Detail
Legal Name
*
Trading Name
*
Trading Address
City
Postcode
*
Company Number
*
Vat Number
*
Phone Number
*
Email Address
*
Website Address
*
Business Type
*
Director/ Propritor Name & Address
*
Date of Birth
*
Date of Birth
*
How Long Have You Been Trading?
*
Home Owner Or Tenant?
*
Contract Lenght
*
Terminal Modal & Qty
*
Pax A-920 Pro
Ingenico Move 5000
Ecom / Pos?
*
Ecom
Pos
Epos Model No.
*
Wifi/Telephone Line
*
Yes
No
Average Transaction Value
*
Annual Turnover
*
Terminal Model
*
Quantity
*
1
2
3
4
Price
*
Sim Card Required
*
Yes
No
Moto Required
*
Yes
No
Charging Base Required
*
Yes
No
Existing Acqurier
*
Acqurier
*
Term Left In Contract
*
Consumer Rates “Visa”: Debit/C =
*
Consumer Rate
Consumer Rates “MasterCard”: Debit/C =
*
Consumer Rate
Consumer Premium Card “Visa”: Debit/C =
*
Consumer Rate
Consumer Premium Card “MasterCard”: Debit/C =
*
Consumer Rate
Consumer Rates “Visa”: Credit/C =
*
Consumer Rate
Consumer Rates “MasterCard”: Credit/C =
*
Consumer Rate
Consumer Premium Card “Visa”: Credit/C =
*
Consumer Rate
Consumer Premium Card “MasterCard”: Credit/C =
*
Consumer Rate
Commercial / Corporate rates “Visa”: Debit/C =
*
Commercial Rate
Commercial / Corporate rates “MasterCard”: Debit/C =
*
Commercial Rate
Commercial / Corporate rates “Visa”: Credit/C =
*
Commercial Rate
Commercial / Corporate rates “MasterCard”: Credit/C =
*
Commercial Rate
Rest of world cards “Visa/Mastercard”: Debit/C =
*
Rest of the World
Rest of world cards “Visa/Mastercard”: Credit/C =
*
Rest of the World
The European Economic Area (EEA):
*
Rest of the World
Auth Fee / Transaction Fee:
*
Pre Auth Fee / Transaction Fee:
*
Non Secure Fee:
*
PCI Compliance:
*
American Express Services Required:
*
Decline Rate:
*
Refund Rate:
*
Payment Gateway Monthly Fee (Ecommerce Only):
*
Miscellaneous / Software Charges:
*
Till Roll box of:
*
Submit
Form Has Been Submitted.