Business legal name
Trading as name
Type of business
Limited Company
Sole Trader
Partnership
Charity
Provide registered company number
State the exact Shareholding splits per director/shareholder
Business Trading start date
DD slash MM slash YYYY
Business Website Address
This field is hidden when viewing the form
Business website address
VAT Number
If you would like to take AMEX payments please provide your AMEX account number
Trading address
Street Address
Address Line 2
City
Postcode
Number of terminals required
How many trading address locations
1
2
3
4
5
6
7
8
9
10
Expected total business turnover on cards per annum
Contact name
(Required)
Correspondence email
(Required)
Business email (if different from correspondence email)
Contact phone number
(Required)
Business owner main ID
Max. file size: 64 MB.
Business bank statement
Max. file size: 64 MB.
Proof of home address
Max. file size: 64 MB.
Time at home address above less than 3 years
Previous home address
Street Address
Address Line 2
City
Postcode
How many directors and/or shareholders with 25% or more equity
Please enter a number from
1
to
5
.
Director/ shareholder 1 name
Director/ shareholder 1 ID
Max. file size: 64 MB.
Director/ shareholder 1 proof of address
Max. file size: 64 MB.
Director/ shareholder 2 name
Director/ shareholder 2 ID
Max. file size: 64 MB.
Director/ shareholder 2 proof of address
Max. file size: 64 MB.
Director/ shareholder 3 name
Director/ shareholder 3 ID
Max. file size: 64 MB.
Director/ shareholder 3 proof of address
Max. file size: 64 MB.
Director/ shareholder 4 name
Director/ shareholder 4 ID
Max. file size: 64 MB.
Director/ shareholder 4 proof of address
Max. file size: 64 MB.
Director/ shareholder 5 name
Director/ shareholder 5 ID
Max. file size: 64 MB.
Director/ shareholder 5 proof of address
Max. file size: 64 MB.
Merchant
Worldpay
Verofy
Teya
Shift4
Screenshot of online advertisement with store details
Max. file size: 64 MB.
Photo of your store, including clear signage with your store name
Max. file size: 64 MB.
Receipt provided to a customer
Max. file size: 64 MB.
Statement from previous payment provider (dated within last 3 months)
Max. file size: 64 MB.
Utility bill addresses to your business (dated within last 3 months)
Max. file size: 64 MB.
Lease agreement for your store address (dated within last 3 months)
Max. file size: 64 MB.
Invoice addressed to your business (dated within last 3 months)
Max. file size: 64 MB.
Upload Proof of business
Max. file size: 64 MB.
Upload ID
Max. file size: 64 MB.
Please upload government issued ID. If uploading a driving license, please provide back and front
Anything else we need to know or any specific questions you’d like answered before we process your application?
