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User Registration
Credential Information
First_Name
Last_Name
User_Email
Your email will not ever be shared!!
Phone_Number
Password
( at least 8 characters )
Confirm Password
Company information:
Company Name
Company Address
City
State / Province
Zip Code/Post Code
Company Country
Company Web URL
Company Product
Company Product Description
Customer Service Information:
Support Contact Full Name
Customer support phone
Customer support email
Owner / Manager Information:
Owner's Full Name
Owner's Address
City
State
Zip Code/Post code
Owner's Country
Owner/Manager's Email:
Owner's Passport/ID
Owner's Phone
Owner's Skype or Social Media
Owner's SSN/EIN
SSN/EIN Display
Processing History Information:
Do you accept credit cards
No
Yes
Have you ever processed before ?
No
Yes
Have you ever had a Merchant Account terminated ?
Time with Processor
Former/Current Processor
Other Information:
How did you Hear About Us
Sales Person
Search Engine
TV Commercial
Radio Commercial
News Paper ADS
Facebook
Twitter
Linkedin
Youtube
Other
Agent Name
( If don't know, just Type in No . )
Agent Id
( If don't know Skip this field . )
Transaction Information:
Sales amount per Month
$
Times of transaction Monthly
Max ticket Amount($)
$
Min ticket Amount($)
$
Transaction Description
Application Date
*
Application Status
Pending
Approved
Declined
Suspended
*
Application Completed ?
No
Yes
Agreement and Service terms of Service:
I agree to the terms and conditions, click here to read policy douments
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Password must contain the following:
A
lowercase
letter
A
capital (uppercase)
letter
A
number
A
special character
Minimum
8 characters