Payment Facilitator Certification Intake Form


Please submit your details for Payment Facilitator Certification


Overview


{{updateValidationErrorMessage('businessName1','required')}} {{updateValidationErrorMessage('businessName1','min')}} {{updateValidationErrorMessage('businessName1','max')}} {{updateValidationErrorMessage('businessName1','regex')}}
{{updateValidationErrorMessage('DBA','required')}} {{updateValidationErrorMessage('DBA','min')}} {{updateValidationErrorMessage('DBA','max')}} {{updateValidationErrorMessage('DBA','regex')}}
Are you processing live Visa transactions? (required)
{{updateValidationErrorMessage('processinglive','required')}}
{{updateValidationErrorMessage('websiteUrl1','required')}} {{updateValidationErrorMessage('websiteUrl1','regex')}}

Key Contact Person Details


{{updateValidationErrorMessage('businessContactFirstName1','required')}} {{updateValidationErrorMessage('businessContactFirstName1','min')}} {{updateValidationErrorMessage('businessContactFirstName1','max')}} {{updateValidationErrorMessage('businessContactFirstName1','regex')}}
{{updateValidationErrorMessage('businessContactLastName1','required')}} {{updateValidationErrorMessage('businessContactLastName1','min')}} {{updateValidationErrorMessage('businessContactLastName1','max')}} {{updateValidationErrorMessage('businessContactLastName1','regex')}}
{{updateValidationErrorMessage('personalEmail1','required')}} {{updateValidationErrorMessage('personalEmail1','max')}} {{updateValidationErrorMessage('personalEmail1','email')}}
{{updateValidationErrorMessage('businessPhoneNumber3','required')}} {{updateValidationErrorMessage('businessPhoneNumber3','min')}} {{updateValidationErrorMessage('businessPhoneNumber3','max')}} {{updateValidationErrorMessage('businessPhoneNumber3','numeric')}}
{{updateValidationErrorMessage('trans1','required')}}
{{updateValidationErrorMessage('geo1','required')}} {{updateValidationErrorMessage('geo1','min')}} {{updateValidationErrorMessage('geo1','max')}} {{updateValidationErrorMessage('geo1','regex')}}
Please select the statements that describe your company’s capabilities (leave partial yes answers blank):