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THE KING OF PAYMENTS®

ENTER YOUR COMPANY DETAILS BELOW

Legal Name Of Company

Registered DBA/Tradename (if applicable)

Country Of Incorporation

Country Of Incorporation Of Parent Company (if applicable)

Name Of Ultimate Beneficial Owner(s)

Nationality Of Ultimate Beneficial Owner(s)

Detailed Description Of Products / Services Sold (explain business model)

Delivery Time For Goods Or Length Of Membership

Websites(s) (please separate by commas)

Username / Password (if applicable)

Are You Currently Accepting Credit Cards?
Yes No

If Yes, How Long?

Average Transaction Value

Monthly Sales Volume

Desired Currencies

Desired Settlement Currencies

Number Of Chargebacks Last Month

Chargebacks-To-Sales-Ratio (%) Last Month

Additional Notes

Contact Email Address