Online Form

Online Application

Details

First Name

Last Name

Email Address

Your Phone Number

Services Required

Business Name

Region

Website Address

Company Email

Business Phone Number

Number of Employees

Business Model Description

Business Category

Sub-category for Crypto

Does The Company Have A License

Yes No

Registered Company Name

Country of Incorporation

Company Number

Incorporation Date

(TIN), Or (UTR) Number

Type of Business

Registered Address

Principle Place of Business

How many Directors are there in total?

Type of Director

Full Name of the Director

Date of Birth of the Director

Nationality

Passport or Identity Document

Choose a file

Max. size: 64.0 MB

Proof of Address (dated within 3 months)

Choose a file

Max. size: 64.0 MB

How many shareholders are there in total?

Are any shareholders corporate entities?

Yes No

Percentage of Shareholding

Full Name of the Shareholder

SHAREHOLDER: Is the shareholder a physical person or a parent company (entity)?

Upload a clear colour copy of the shareholder’s identity document or passport or drivers license

Choose a file

Max. size: 64.0 MB

Upload the utility bill or bank statement containing the residential address for the shareholder (dated within last 3 months)

Choose a file

Max. size: 64.0 MB

Certificate of Incorporation

Choose a file

Max. size: 64.0 MB

Articles of association and/or memorandum of association

Choose a file

Max. size: 64.0 MB

Proof of Address (dated within the last 3 months)

Choose a file

Max. size: 64.0 MB

Do you have additional documents you wish to upload?

Yes No

Where will you accept payments?

Which features do you require?

How long have you been trading?

What is the average transaction value in your business?

What is your estimated monthly turnover via card payments?

Do you currently accept cards?

Yes No

Please explain how you plan to prevent fraud and Recalls / chargebacks?

Confirmation

I confirm all form fields have been completed as accurately as possible.

User ID