Pre Application Approval Sheet

Company Information

Details

Company name and legal form:

Street:
Zip Code:
City:
Country
Site/URL:
Phone:
Company - URL:
E-Mail:
VAT ID.:
Company Owner

Details

First Name:
Surname:
Company Director Details

Details

First Name:
Surname:
E-Mail:
Personal address Str:
Personal address Zip Code:
Personal address City:
Personal address Country:
Tel.:
Transaction & Processing Details

Details

Transaction Currencies:
Settlement Currencies:
Processing History
1. Please attach the processing history for the last 6 months from the merchants previous processor (Split into credit card
type, month, volume, transactions, chargeback volume and number of chargeback's) - Please see Processing History Tab

OR
2. If this is a new merchant operating company, please attach a forecast of the anticipated volume for the following 6
months (split into the criteria mentioned above)
Average transaction size

credit card (only Visa and Mastercard) split per country/ region
% of Domestic Business/Transactions
% of Intra EEA Business/Transactions (27 member
Europe states, excl. Domestic)
% of Intra Western Business/Transactions (Switzerland,
Israel, Norway)
% of Intra Eastern Business/Transactions (Bosnia,
Croatia, Russia, Serbia, Turkey,)
% of International Business/Transactions (worldwide,
excl. Domestic and Europe)
Processing volume by card scheme (monthly; estimated)
% Visa
% MasterCard
% Maestro
% Diners/ Discover
% JCB
Amount of processed transactions (monthly; estimated)
Visa
MasterCard
Maestro
Diners/ Discover
JCB
distribution of credit vs. debit cards
% credit cards
% debit cards
% commercial cards
3D Secure?
with or without 3D-Secure (Verified by Visa/ Mastercard Securecode) or both?
Recurrent transactions (in %)

VISA
Information Required

Last month

2 Months ago

3 Months ago

Sales volume
No. of transactions
Volume chargeback
No. of chargebacks
Volume of refunds
No. of refund transactions

Mastercard
Information Required

Last month

2 Months ago

3 Months ago

Sales volume
No. of transactions
Volume chargeback
No. of chargebacks
Volume of refunds
No. of refund transactions

Debit Cards(eg Maestro etc)

Additional Card Type
Information Required

Last month

2 Months ago

3 Months ago

Sales volume
No. of transactions
Volume chargeback
No. of chargebacks
Volume of refunds
No. of refund transactions

Other Cards (Please Specify)

Additional Card Type
Information Required
Sales volume
No. of transactions
Volume chargeback
No. of chargebacks
Volume of refunds
No. of refund transactions

Last month

2 Months ago

3 Months ago

VISA
4 Months ago

5 Months ago

6 Months ago

TOTAL

4 Months ago

5 Months ago

6 Months ago

TOTAL

5 Months ago

6 Months ago

TOTAL

5 Months ago

6 Months ago

TOTAL

stercard

s(eg Maestro etc)

4 Months ago

s (Please Specify)
4 Months ago

VISA/Mastercard
Information Required
Sales volume
No. of transactions
Average Ticket Size

First month

in 2 months

in 3 months

Mastercard
in 4 months

in 5 months

in 6 months

TOTAL