Pre Application Form | GlobalPayGate

Subject *

Your Name *

Phone Number

Your Email *

Company Name *

Street *

Zip *

City *

Country *

Website *

Part of a Group of Companies

Yes

No

Product / Services *

Is The Companys Activity Subject To Any Licensing *

Yes

No

Do you offer Subscriptions *

Yes

No

Do you offer free Trials

Yes

No

Detail your membership packages

Do you offer an Affiliate Program *

Yes

No

Do you Ship products

Yes

No

What are the shipment fees and delivery time

Do Customers get a track and trace

Yes

No

Specify all methods of Delivery

Have you processed Payment Before *

Yes

No

How long have you been processing payments

Estimated Monthly Volume *

Estimated Monthly Transactions *

Average Transaction Value *

Minimum Ticket Size *

Maximum Ticket Size *

Processing Currencies *

EUR

GBP

USD

Settlement Currencies *

EUR

GBP

USD

Require Crypto Settlements

Yes

No

ChargeBack (%)

Fraud (%)

Domestic (%) *

EU (%) *

Non EU (%) *

Other Gateway

Hosted Payment Page *

Yes

No

If you use the payment page of an extenal provider, select Yes, if you will have your own payment page, select No You will need to be PCI compliant.

PCI DSS Compliant

Yes

No

3DS Needed from Acquirer

Yes

No

Notes

Certificate of Incorporation

Memorandum of Association

Bank Statement

Processing History

Diagram of Company Structure

Copy of License

PCI Certificate

Proof of ID UBO

Proof of Address UBO

Additional Documents

For all companies who owns more than 25% of the shares, please upload here the certificates and Memorandum of Associations and for all UBO's own more then 25% of the shares a proof of ID and Proof of address