Merchant Application www.AdultWebsitePayments.com


	NEW MERCHANT REGISTRATION - Pre-Application

*Company Name:

Company legal name or registered name.

*DBA Name (if
different):

*Business Type:

Or:

*Company Address:

Company Address - Physical Address or main office.

*City:

City

*State ( US Only ):

State - If US Only

*Province or District
- Canada:

Canadian Provine - Canadian Only.

*Province or District
( Non-US or CA ):

Province or District - For all Non-US or Non-Canadian Merchants.

*Postal Zip Code:

Postal or Zip Code.

*Website URL:

URL of Website: http://www.YourDomain.com


	COMPANY PROFILE

*Date Business
Established:

/ /	Date the business was started / Registered.

*Business Description:

(chars left: 500)

Business Description: Day to day operations and proceedures - main products or services offered.

*Marketing and
Promotion Methods::

(chars left: 500)

Describe the marketing and promotional methods used to advertise this business - a.e. newspaper, inbound telemarketing, yellow pages, ect...

*Customer Service:

(chars left: 500)

Describe how customer service works when contacted for help or support.

*Refund /
Cancellation Policy:

(chars left: 200)

Describe merchants Refund & Cancellation Policy.

*Delivery or Shipping
Methods:

(chars left: 500)

Delivery or Shippong Methods - Example: Digital Downloads after payment received. - or - UPS and FEDEX with delivery confirmation - shipped within 24 hours.......


	RISK ASSESSMENT PROFILE

*Membership:

YES

NO

Is this business membership based ?

*Bankruptcy:

YES

NO

Has the Business or Owner ever filed for Bankruptcy ?

*Terminated Merchant
File:

YES

NO

Has the Applicant or Business ever been terminated?

*Processing History:

YES

NO

Does the applicant have previous or current processing history for this business ?

*Payment Options:

Specify all other options of payment accepted other than credit cards accepted by applicant.

*Customer Origin:

List major countries that merchants customers come from.

*Reason:

What is the reason you are applying for this merchant account ?


	OWNER - MANAGER INFORMATION

*First Name:

First Name

*Last Name:

Last Name

*Telephone:

- - x

Owner / Manager Telephone Number

*Fax Number:

- -	Fax Number to send contract or documents for signature.

*Cellular / Mobile:

Cell phone or mobile phone number.

*International Phone:

International phone number can be entered here.

*Title:

Or:

Title of Applicant

*DOB (YYYY-MM-DD):

Date of birth format: DOB (YYYY-MM-DD)

*Email List:

Enter multiple email addresses on separate lines. ** Include applicant listed here and up to 3 other contact emails on separate lines.

Referral - Agent: