Application to process credit cards

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Date Required

Contact Information
First Name			Last Name
Work Phone		Mobile	Home		Fax
Email			Confirm Email
	Please make sure the email above is correct as this is the main point of contact (you are asked to enter the email twice - in the Confirm Email - as a validation measure)

Company Information
Trading Name			Legal Business Name
Company No		GST No
Description
	Description of Busines and Stock
Trade Associations
	Any Trade Associations that you are currently a member of

	Business Address			Mailing Address (if different to your business address)
Building			Building
Street Address			Street Address
Suburb		Town / City	Suburb		Town / City
Postcode		Country	Postcode		Country

Sales Information
Annual Turnover ($)		CC Sales (%)	Average Sale ($)		International Sales (%)
Sales with Delivery Period (%)		Days National Delivery	Days International Delivery
Deposit Charged?	Do you charge a deposit?	Deposit Percentage (%)	Deposit Days in Advance

Account Information
Bank Account for Settlement			Bank Account for Fees
Other Merchant Name			Other Merchant Number
	Either existing or previous merchant details

Website Information
Website			Developer
Developer Phone			Developer Email
Additional Information

Director(s) Information

	Director 1
First Name		Middle Name	Last Name		Gender
Date of Birth			Citizen of		Occupation
Drivers Licence		Licence Version	Drivers Licence Expiry
	Current Residential Address	Need Prev Address?		Previous Residential Address (If less than 5 years at current)
Building			Building
Street Address			Street Address
Suburb		Town / City	Suburb		Town / City
Postcode		Country	Postcode		Country


	Director 2
First Name		Middle Name	Last Name		Gender
Date of Birth			Citizen of		Occupation
Drivers Licence		Licence Version	Drivers Licence Expiry
	Current Residential Address	Need Prev Address?		Previous Residential Address (If less than 5 years at current)
Building			Building
Street Address			Street Address
Suburb		Town / City	Suburb		Town / City
Postcode		Country	Postcode		Country


	Director 3
First Name		Middle Name	Last Name		Gender
Date of Birth			Citizen of		Occupation
Drivers Licence		Licence Version	Drivers Licence Expiry
	Current Residential Address	Need Prev Address?		Previous Residential Address (If less than 5 years at current)
Building			Building
Street Address			Street Address
Suburb		Town / City	Suburb		Town / City
Postcode		Country	Postcode		Country


	Director 4
First Name		Middle Name	Last Name		Gender
Date of Birth			Citizen of		Occupation
Drivers Licence		Licence Version	Drivers Licence Expiry
	Current Residential Address	Need Prev Address?		Previous Residential Address (If less than 5 years at current)
Building			Building
Street Address			Street Address
Suburb		Town / City	Suburb		Town / City
Postcode		Country	Postcode		Country

		The Controls
1	Item 1
2	Item 2
3	Item 3
4	Item 4
5	Item 5
6	Item 6
7	Item 7
8	Item 8
9	Item 9
0	Item 10
The selected Items

Application to process credit cards

Contact Information

Company Information

Business Address

Mailing Address (if different to your business address)

Sales Information

Account Information

Website Information

Director(s) Information

Director 1

Current Residential Address

Previous Residential Address (If less than 5 years at current)

Director 2

Current Residential Address

Previous Residential Address (If less than 5 years at current)

Director 3

Current Residential Address

Previous Residential Address (If less than 5 years at current)

Director 4

Current Residential Address

Previous Residential Address (If less than 5 years at current)

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