Merchant Acquiring request form

Your name *

First

Last

Your email *

Your phone Number *

Main trading URL *

If more, than one trading URL, please list those here: *

Please specify in case of "other" for card brand: *

Company name *

Country of incorporation *

Incorporation number *

Countries you are / would like to receive cards payments from: *

Would you need to process credit to a card (OCT/CFT): *

Yes No

If yes, what would be an average payment amount? *

Your current Payment Service Provider (PSP): *

Your current acquiring bank: *

Monthly figures per card brand for inbound payments:

Visa Credit #: *

Volume in your local currency: *

Visa Debit #: *

Volume in your local currency : *

MasterCard Credit #: *

Volume in your local currency: *

MasterCard Debit #: *

Volume in your local currency: *

Other Card brands #: *

Volume in your local currency: *

What PCI DSS level of your company? *

Level 1 Level 2 Level 3 Other

Please specify for "other" for PCI DSS: *

Do you use 3D Secure? *

Yes, we are processing through 3DS No Sometimes we use 3DS and sometimes not other

Please specify for "other" 3DS: *

MasterCard chargeback ratio *

< 0.5 % from entire volume > 0.5 % from entire volume

MasterCard # of chargeback *

< 50 per month > 50 per month

Visa chargeback ratio *

< 1.5 % from entire volume > 1.5 % from entire volume

Visa # of chargeback *

< 200 per month > 200 per month

Merchant acquiring request form