i . p . m

Pre-qualification Form

With the information you provide, we will determine whether we can assist you with obtaining your credit card merchant account(s). Once your pre-qualification form is approved, you will be required to complete the application process.

*All fields are required You may want to print the form first to make sure you have all the information. Click the "Print this page" link at the upper right of the page to print from your browser.


Company name as it appears on company register	:
Doing Business As (dba), if applicable	:
Company registration number	:
Legal form of company (type)	:
Name of person in charge of account administration as it appears on passport	:
Company address where business is operated	:
Address from which business is registered if different from above	:
Country of incorporation	:
Date business was established	:
Official owner	:
Names of directors and their % of ownership or number of shares	:
Detailed description of company structure re officers, directors, shareholders	:
Name of CEO	:
CEO email	:
Business phone number	:
Mobile phone number	:
Name and Email address of contact person	:
Products/services sold	:
URL(s) where products will be sold	:
Description of core business, target markets and countries where goods are sold	:
Annual Revenue	:
Average ticket amount	:
Transaction Limit (largest possible individual sale you anticipate for a customer)	:
Monthly credit card sales	:
Number of monthly transactions	:
Chargeback % last 6 months	:
Desired processing currency	:
Desired settlement currency	:
Currently processing or terminated	:
Current processor	:
Referred By	:
Comments or additional information	:

Your URL must be Visa/MC compliant by having the following information clearly posted on it:

The company’s legal name on the website
The domain name must be registered in the company’s name
A section dedicated to customer service indicating a telephone number or email address
A section dedicated to a refund and return policy
A clear posting or description of products/services sold/provided with pricing stated in the settlement currency
A secure/ SSL website order/payment page

You will be required to submit the following supporting documents referred to as KYC (know your client):

Color copy of both sides of a valid National ID such as an official passport or both sides of a driver's license only. Any individual owning shares for more than 25% will be required to submit a photo ID.
Proof of Address such as a utility bill or bank statement only, not older than 3 months. The address on these documents must match the business address you have submitted on your questionnaire.
Certificate of incorporation
Details of business activity & share ownership including the percentage of the shares and monetary value with names of company directors listed on company letter head.
Three months’ most recent processing statements.

The next step will be to sign an agreement with your fees and terms. Following this step, you will open an account with us and begin the integration process.

*All fields are required. If the Submit button doesn't work, scroll back up and make sure there are no blank fields. You may want to print the form first to make sure you have all the information.