Merchant Application Form – Hr. Merchant Services

CREDIT CARD PROCESSING PRE-APPLICATION FORM

Section 1 – Company Information

All fields in this section are mandatory

Legal Business Name :

Address :

City

Zip Code

Country

Telephone Number

Fax Number :

Shop URL :

.This is the URL where you sell your product(s): Please name ALL URLs you operate. Use a separate sheet if necessary.

.You must provide a non-expiring Username and Password for your website(s).

Corporate URL :

.This is the URL with contains corporate information of different from Shop URL.

Section 2 – Company Director Information

All fields mandatory

Full Name :

Address :

City

Zip Code

Country

Phone Number

Email address :

Percentage ownership in Operations company :

Date Of Birth

Section 3 Credit Card Processing Information

(mandatory)

Credit Card Descriptor? (if applicable)

Name of Current Processor(s):

Which countries or geographic regions are you targeting?

Section 4 – Business Model Description

Please provide a detailed description of the goods and/or services you offer.

Who is your Target Market?

How do you fulfill your Customers’ Orders?

How do you offer products and / or services? (Internet, Direct Mail / Telemarketing)

What are the products and / or services?

Who are your suppliers of your products and/or services?

How do you receive your Customers’ Orders?

For new businesses / Shops please show the next six months forecast

show each account separate (please use tables below)

Account 1:

VISA
Date/Month

VISA Sales
in $

Number of
Sales TRX*

Charge back
volume in $

Chargeback
TRX Count

Account 2:

MASTERCARD
Date/Month

MC
Sales in $

Number of
Sales TRX*

Charge back
volume in $

Chargeback TRX Count

Section 5 – Last six months’ credit card processing data (optional)

Document Submission Instructions

After submitting this application, Kindly email the following documents to:

admin@hrmerchant.com

Required documents:
• Government-issued ID
• Business registration documents
• Void check or bank letter
• Processing statements (if available)

Also include your Business Name in the email subject line.

Name :

Title :

Signature :

Date :

Numeric Field