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Shop
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.