Merchant Application Form – Hr. Merchant Services

FULL MERCHANT APPLICATION (PRIVATE)

This is a private application form.

You have been pre-approved to proceed with the full merchant application.
Please complete all required fields accurately. Our team will review and contact you shortly.

Section 1 – Company Information

All fields in this section are mandatory

Legal Business Name :

Telephone Numbers

Fax Number

Address :

City

State

Zip Code

Country

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

First Name

Last Name

Phone Number :

Email address :

Percentage ownership in Operations company :

Date Of Birth

Address :

City

State

Zip Code

Country

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?

Financial Overview / Forecast

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 our secure server:

partners@transmitpay.com

Subject:
Your Business Name

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

Thank you and looking forward to working with you.

Enter Your Name As Signature :

Date / Time