Mashreq Merchant ServicesUnit

mashreq Retail Banking Group

Post Box 1250,Dubai
TCI (04) 4244444

MERCHANT REMOVAL FORM

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MERCHANT ID YERM'NAL COUNT GROUP

NAME

L0CAIT0N

CITY BLDG NAME 14t>S Shop no

P.O.BOX P.O.BOX CITY

CONTACT

TITLE rnjn
TEL 1 FAX

TEL2 MOBILE Duq(,

MASEREQBÄNX MERCHANT SERVICES UNIT INSTALLED A POINT OF SALE TERMINAL AT

YOUR OUTLET/s.WEARE REMOVING THE TERMINAL FROM YOUR ESTABLISHMENT
TO TEE FOLLOWING REASONS:

COMPETETION
COMPETITOR NAME SHOP CLOSED

NO CARD BUSINESS SUSPECTED FRUAD OTHERS

XINDIX OVER pos TERMINAL ALONG ALL,pos RELATED

TEE MONTHS TRANSACTIONSe
WE FOR CONSIDRING SERVICES

RECEIVED FROM SIGNETüRE & DATE

24
två.huxnad Irfan

COLLECTED BY Staff 27036 SIGNETURE & DATE

TERMINALMODEL:bYC C) SERIAL NO:

Classification: Restricted - Business Use