Payment Facilitator Certification Intake Form

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Overview

Company Legal Name (required)

Company DBA (required)

Are you currently processing live Visa transactions? (required)

Yes

Company Website (required)

Key Contact Person Details

Business contact first name (required)

Business contact last name (required)

Email address (required)

Phone Number (required)

How many total transactions do you process each year? (required)

Which countries do you operate in? (required)

Please select the statements that describe your company’s capabilities (leave partial yes answers blank):

Sell goods and/or services to Visa cardholders and book the sale as revenue and process the transaction in one step i.e. from the issuer of the funding to the acquirer of the merchant

Directly contract with an acquirer and have a direct funds settlement arrangement with the acquirer

Have your own acceptance mark at multiple merchants and are capable of processing a back-to-back purchase transaction

Capable of storing customer funds, have your own acceptance mark at multiple merchants, and are capable of processing a back-to-back purchase transaction

Aggregate merchants by signing agreements involving handling of funds, manage settlement with the seller, and ultimately resolve customer disputes

Bring together cardholders and retailers on an online or mobile app and have your brand featured prominently on the website/mobile app

If yes to the above, do you resolve cardholder disputes by providing a decision that binds both the cardholder and retailer; or provide a money back guarantee?

Store a credential (account or token) supplied by the cardholder and complete a transaction by transferring the stored credential to the merchant without interrupting the flow of funds

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