Merchant Application pre-vet
Please provide requested details as pre-qualification submission to Merchant Acquiring providers for consideration to provide Card Acquiring services.
Business Registered Name
*
Company Number
*
Applicants Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Business Registered Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Trading Address (if different from Registered).
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Details - Please provide details of Products and Services Offered and what the cardholder will be paying for.
*
Please provide Company URL/s.
*
Are you currently accepting card payments
*
Yes
No
If yes, please provide name of provider
Services Required
*
Ecommerce
MOTO
POS
CRYPTO
Projected 12 month card turnover
*
Average Transaction Value
*
ATV
Chargeback Last 6 months
*
Count
Chargebacks Last 6 months
*
Value
Refunds Last 6 months
*
Count
Refunds Last 6 months
*
Value
Projected Service Delivery Days
*
Is License required?
*
Yes
No
If yes, please provide details of Jurisdiction and License(s) held
Director(s) and Shareholder(s)
Name
*
Director
*
Yes
No
Shareholder
*
Yes
No
Shareholding %
Name
Director
Yes
No
Shareholder
Yes
No
Shareholding %
Name
Director
Yes
No
Shareholder
Yes
No
Shareholding %
Silk Road Kapital Ltd - SUITE 8, 4TH FLOOR WEST WORLD, WEST GATE LONDON W5 1DT
By Submitting this form, you are authorising Silk Road Kapital Ltd to submit these details to its partner network of merchant acquiring banks as an initial pre-vet to seek approval for a full merchant account application.
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