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BECOME A MEMBER

AN ACCOUNT WILL BE OPENED AND A MEMBER OF THE TEAM WILL BE IN TOUCH

1. AGENT REPRESENTATIVE INFO


2. BILLING


3. FINANCIAL CONTACT


4. TECHNICAL SUPPORT CONTACT


MERCHANT ACCOUNT FORM

MANAGED BY


5. ENTITY TYPE


6. PRINCIPALS*

Directorship
Majority Ownership
*Please list additional Directors, or Shareholders with a 25% or greater stake in the entity, in Section 10 (Business Model / Notes), or submit the details separately. Ensure that ultimate beneficial ownership is clearly described.

7. CURRENT STATUS


8. ANTICIPATED


9. URLS


10. BUSINESS MODEL/NOTES


By submitting this application, you assert the details provided are true to the best of your knowledge. The details may be used for monitoring and reporting purposes. If you have any queries, please contact your representative for timely assistance.

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