Merchant Pre-Application

Full name*

Email*

UBO(s) and % of interest (list all with 25% or more interest)*

Company legal name*

Registration number*

Registered address*

Business address (if different from registered address)

Place of incorporation*

Date of incorporation*

License information (if applicable)

Name of authority who issued

Place of issuance*

Expiration date*

Prior bankruptcy*

Yes

No

Interested GEOs*

Brazil

Peru

Colombia

Mexico

Chile

Europe

US

Requested monthly sales volume ($)*

Average ticket…*

Total annual turnover*

High ticket ($)*

Low ticket ($)*

% of volume (VISA)*