Merchant Application Form (Payment Gateway)

Business Details

Business Name*

ABN Number

Registered Legal Address*

City*

State/Region*

Postal code*

Year founded*

Business Website Name*

About Your Business

Industry Type*

Estimated Annual Turnover*

Estimated Card Volume*

Average Transaction Size*

Do you provide refunds*

Maximum refund amount*

Number of refunds per month*

Payment Methods

Card Present*

Internet*

Moto*

If your customers leave a deposit

What percentage of the sales value is the deposit amount*

Minimum number of days for delivery from date of deposit?*

How long from time of payment are the goods/services delivered?

0 Days*

1 - 7 Days*

14 Days or more*

Beneficial Owner 1

Full Name*

Position*

Mobile Number*

Email Address*

Street Name and Number*

Suburb*

Postcode*

State*

Benefical Owner 2 (if applicable)

Full Name

Position

Mobile Number

Email Address

Street Name and Number

Suburb

Postcode

State

Settlement Account Details

Account Name*

BSB*

Account Number*

Bank Name*

Trust Account*

Identification Documentation for Verification

Drivers License (front & back)*

Medicare Card*

Business Bank Statement*

What you agree to:

This Merchant Agreement is comprised of
1. The Collection Statement;
2. The General Terms;
3. The Merchant Application Form signed by the Company;
4. Any additional document listed in the Application (as and where applicable)

By signing this Merchant Agreement Application Form, you:

1. acknowledge having received, read and understood the Merchant Application Form and agree to be bound by same;
2. agree to the use and disclosure of your personal information as set out in the Collection Statement and agree to be bound by the privacy obligations as detailed in the General Terms and the Collection Statement;
3. warrant that the information provided in this Application is correct and not misleading;
4. warrant that you are duly authorised to agree to the debiting and crediting of payments to the account or accounts nominated in this Application; and
5. warrant that any individual signatory is authorised to enter into this Merchant Agreement on behalf of the Merchant.
6. agree that VisionPay does not provide a currency exchange service. VisionPay permits you to accept cash out and sales transactions in multiple currencies. You are not entitled to receive the value of those transactions in which they are denominated. VisionPay will determine the value of transactions having regard to the currency in which you would prefer to settle on the day and at such rates as it considers appropriate.

If your business is (i) a company - the application must be signed by a Vice President (c-level) or higher, (ii) an incorporated non-profit - the application must be signed by a Vice President or higher, (iii) a partnership - the signatories should constitute 51% or more of the ownership of the business or be signed by the managing partner as evidenced by the partnership agreement, (iv) a sole trader - the signatory should be the sole trader or (v) a trust - the signatory should be the trustee or the person named (either a company or an individual) on the trust deed.

Do you agree to the above terms and conditions*

Yes