Pre-approval form

General company information

Company name

Registration number

VAT number

Country of Incorporation

Information about company involved persons  (board, shareholders)

Name

Date of Birth

Surname

Citizenship

Information about business activity

Dropdown

Other

Business description

Does your business require special permission/license?

No
Yes

Who is your current payment services processor?

Which Payment Gateway(Cashier) will you use

Own
White Label

Name of WL Payment Gateway/Cashier

Payment Page

Redirect (MTBX Payment Page)
Iframe
S2S

Is the company PCI DSS Compliant?

No
Yes

Information about the e-project

URLs

Business operated since

Months

Year

GEOs of customers, %

%,EU

%,USA

%,CIS

%,Asia

%,Other

Card brands required

VISA
MC
China Union Pay
Discover

Additional features required

Tokens
Recurring payments

Financial information

Processing currency

USD
EUR
GBP
CAD

Additional currency

Current monthly volumes

Currency

Amount

Count

Expected monthly volumes via MBTX

Currency

Amount

Count

Average monthly chargebacks

Currency

Amount

Count

Average monthly refunds

Currency

Amount

Count

Transaction amount

Currency

Min

Max

Average