2015 Merchant Application Form 2017-01-25T11:17:55+00:00

Merchant Application Form

Please note all fields are mandatory

  • For JetPay usage only



  • 1. Company Information

  • Merchant Company Details
  • Merchant Owner's Details
  • Merchant Owner's Details cont'd



  • 2. Merchant Website Information

  • Merchant Company Details

  • DBA name
  • Dynamic Descriptors Required?
  • 3DS Required?
  • MCC code
  • New MCC code
  • Are you PCI DSS compliant?
  • Currencies required - multiselect



  • 3. Processing & Authorisation Information

  • Transaction Details

  • Expected monthly volume (EUR) that will be processed by JetPay
  • European traffic (%)
  • US traffic (%)
  • Rest of World traffic (%)
  • Expected monthly count of transactions
  • Maximum monthly volume in EUR (capped)
  • Average ticket value (EUR)
  • % Volume split between...
  • ... and ...
  • -------------
    IMPORTANT
    6 months processing history and chargebacks are required in order to complete your application.



  • % Volume split between...
  • ... and ...
  • Current chargeback ratio (1)
  • Current chargeback ratio (2)
  • Current chargeback ratio (3)
  • Expected Pricing

  • Merchant End Rate - European traffic
  • JetPay Buy Rate - European traffic
  • Merchant End Rate - US & RoW traffic
  • JetPay End Rate - US & RoW traffic
  • Are you already a client of JetPay?
  • If, No - please key in your..
  • Who is your current Acquiring Bank?
  • Are you leaving your Acquiring Bank?
  • If Yes - please key in the reason below