MERCHANT APPLICATION
Merchant Name
Company Name
Registration Number
Tax Reference Number
VAT Number
Company Address
Contact Number
Email Address (used for all communication)
AUTHORISED DIRECTOR
Name
Surname
ID Number
Mobile Number
Email Address
NOMINATED BANK ACCOUNT
Account Name
Bank
Choose bank
ABSA
AFRICAN
BIDVEST
CAPITEC
CAPITEC BUSINESS
CITI
DISCOVERY
FNB
FIRSTRAND
GRINDROD
GROBANK
INVESTEC
NEDBANK
OLD_MUTUAL
POSTBANK
SASFIN
STANDARD
TYME
UBANK
Branch
Account Number
AUTHORISED USER
(Persons allowed access to the System and responsible for onboarding and managing Members)
Name
Surname
ID Number
Mobile Number
Email Address
Terms and Service Level Agreement
I herewith confirm that I am duly authorised to accept the Terms and Service Level Agreement for and on behalf of the Merchant.
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