Card Processing Application
If multi outlet, please fill out the other trading addresses in the additional information section. Please call if you need further assistance.
Agents Name
Urgent? Are you with the merchant now?
Select an option
Yes
No. Send app to Merchant later
LTD, Sole Trader, Partnership etc
Select an option
Sole Trader
Private Limited Company
Partnership
Other- please comment in additional details box.
Legal Name of Business
Trading Name of Business
Type of Business
Owner/Director email address
Director Phone Number
Trading Address
Trading Address Postcode
Owner/Director First name
Owner/Director Last Name
Owner/Director Date of Birth
Owner/Director Residential address
Owner/Director Postcode
2nd Owner/Director Full Name, DOB and Address, if applicable.
Projected Annual Card Turnover (£)
Estimated Average Transaction (£)
Mastercard and Visa Debit
Mastercard and Visa Credit
Business Debit
Auth fee (£)
Type of Terminal
Type of Terminal
Clover Flex
Clover Mini
Clover Station Duo
Ecommerce
No Terminal
6 Months at £1pm per terminal- if yes then reduced upfront commission
Select an option
No
Yes
Terminal Price
Select Monthly Terminal Price
£13
£14
£15
£16
£17
£18
£19
£20
£21
£22
£23
£24
£25
£26
£27
£28
£29
£30
No Terminal
Virtual Terminal
Clover DUO- add price per terminal in additonal information box
Number of Terminals
Are we submitting to American Express? (Amex will contact them Directly)
Select an option
Yes
No
NAME(S) ON BANK ACCOUNTS
Sort code
Account Number
Any additional information (Additional Outlet etc)
PLEASE SEND SUPPORTNG DOCUMENTS VIA WHATSAPP (07308 842251) OR VIA EMAIL.
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