European company details
Company registration number: / Click here to enter text.
Legal name of company / Click here to enter text.
Registered trade name (if diff. from legal name) / Click here to enter text.
Registered address / Click here to enter text.
Postcode / Click here to enter text.
State (if applicable) / Click here to enter text.
City / Click here to enter text.
Country / Click here to enter text.
Total number of employees / Click here to enter text.
Non - European company details (if applicable)
Company registration number: / Click here to enter text.
Legal name of company / Click here to enter text.
Registered trade name (if diff. from legal name) / Click here to enter text.
Registered address / Click here to enter text.
Postcode or ZIP / Click here to enter text.
State (if applicable) / Click here to enter text.
City / Click here to enter text.
Country / Click here to enter text.
Parent company or subsidiary / Click here to enter text.
Primary contact person
Name / Click here to enter text.
Phone or mobile number (incl. country code) / Click here to enter text.
Email address / Click here to enter text.
Beneficial owners
Beneficial owner #1 / Beneficial owner #2 / Beneficial owner #3
First name / Click here to enter text. / Click here to enter text. / Click here to enter text.
Last name / Click here to enter text. / Click here to enter text. / Click here to enter text.
Email address / Click here to enter text. / Click here to enter text. / Click here to enter text.
Tel/mob number / Click here to enter text. / Click here to enter text. / Click here to enter text.
Current home address / Click here to enter text. / Click here to enter text. / Click here to enter text.
Postcode or ZIP / Click here to enter text. / Click here to enter text. / Click here to enter text.
City
Country / Click here to enter text. / Click here to enter text. / Click here to enter text.
Passport number / Click here to enter text. / Click here to enter text. / Click here to enter text.
Ownership (%) / Click here to enter text. / Click here to enter text. / Click here to enter text.
Directors
Director#1 / Director#2 / Director#3
First name / Click here to enter text. / Click here to enter text. / Click here to enter text.
Last name / Click here to enter text. / Click here to enter text. / Click here to enter text.
Email address / Click here to enter text. / Click here to enter text. / Click here to enter text.
Tel/mob number / Click here to enter text. / Click here to enter text. / Click here to enter text.
Current home address / Click here to enter text. / Click here to enter text. / Click here to enter text.
Postcode or ZIP / Click here to enter text. / Click here to enter text. / Click here to enter text.
City
Country / Click here to enter text. / Click here to enter text. / Click here to enter text.
Passport number / Click here to enter text. / Click here to enter text. / Click here to enter text.
Website details
Applicant website(s)
URL(s) / Click here to enter text.
Test Login details / User ID / Click here to enter text. / Password / Click here to enter text.
Type of business / Click here to enter text.
Primary MCC code if known / Click here to enter text.
Descriptor (DBA Name, max 21 letters, appears on the card statement) / Click here to enter text.
DBA City Field (13 digit customer service phone number incl. country code) / Click here to enter text.
How long have you been in business / Click here to enter text.
Previous/current acquirer / Click here to enter text.
Current monthly sales volume (per currency) / Click here to enter text.
Current number of monthly transactions (per currency) / Click here to enter text.
3-D Secure* / YES ☐ / NO ☐
If YES, which MPI to use? Ours ☐ Other ☐ Enter text.
Desired processing currencies / USD ☐ / EUR ☐ / GBP ☐ / SEK ☐ / NOK ☐ / DKK ☐
AUD ☐ / CAD ☐ / CHF ☐ / YEN ☐ / Other / text.
Terminal type needed / eComm ☐ / MOTO ☐ / Recurring ☐ / 3-D secure* ☐ / Other text.
Card options / VISA ☐ / MasterCard ☐ / Other ☐ Enter text.
*Verified by VISA (VbV) and MasterCard SecureCode
Warehouse and product shipment details(If applicable, only if physical goods are being sold and delivered)
Goods being delivered and sold / Physical goods / Digital content via Internet
☐ / ☐
Shipping and delivery method: / In-house / Fulfilment house / Third party agent / Other
☐ / ☐ / ☐ / Enter text.
If in-house, where is the warehouse location / Same as office address ☐ / Other ☐
Contact person / Click here to enter text. / Email: / Click here to enter text.
If other, please specify the warehouse location / Address / Click here to enter text.
Post code/zip / Click here to enter text.
City / Click here to enter text.
Country / Click here to enter text.
Fulfilment house or Third Party Agent details: / Company name / Click here to enter text.
Address / Click here to enter text.
Post code/zip / Click here to enter text.
City / Click here to enter text.
Country / Click here to enter text.
Contact person / Click here to enter text.
Email / Click here to enter text.
Processing details
Reason for applying for this merchant account? / Click here to enter text.
Projected processing volume? (split down by currency)
1st month / 2nd month / 3rd month
Click here to enter text. / Click here to enter text. / Click here to enter text.
4th month / 5th month / 6th month
Click here to enter text. / Click here to enter text. / Click here to enter text.
Months 7-12 / Year 2 / Year 3
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Projected number of transactions? (split down by currency)
1st Month / 2nd month / 3rd month
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4th month / 5th month / 6th month
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Months 7-12 / Year 2 / Year 3
Click here to enter text. / Click here to enter text. / Click here to enter text.
Product or Service price range / Min / Max
Click here to enter text. / Click here to enter text.
Average value per transaction (average amount per purchase, pls specify per currency) / Click here to enter text.
Split for customer orders (%) / e-Commerce / MO/TO / Other
Click here to enter text. / Click here to enter text. / Click here to enter text.
Volume divided by continent (%) / Europe / USA / Other
Click here to enter text. / Click here to enter text. / Click here to enter text.
Volume divided by card types (%) / VISA / MasterCard / Other
Click here to enter text. / Click here to enter text. / Click here to enter text.
Fraud prevention techniques/scrubbing technologies in place? / Click here to enter text.
Do you block any countries for transactions? Please specify / Click here to enter text.
Website Compliance
Is the company identifiable at all times to the cardholder? / YES ☐ / NO ☐
Company address and contact information clearly presented on the website? / YES ☐ / NO ☐
Refund and return policy clearly presented on the website? / YES ☐ / NO ☐
Do you provide tracking number for goods being sent? (if applicable) / YES ☐ / NO ☐
Do you have insurance for goods being sent? / YES ☐ / NO ☐
Terms and conditions clearly presented on the website? / YES ☐ / NO ☐
Licence for the business clearly presented (especially for pharmacy or gaming) / YES ☐ / NO ☐
Transaction currency is clearly present / YES ☐ / NO ☐
After purchase do you send order confirmation to the cardholder? (Please provide us with a copy) / By post / By email / Other
☐ / ☐ / Enter text.
Customer support available and clearly visible / By telephone / By email / Other
YES ☐ NO ☐ / YES ☐ NO ☐ / Enter text.
Shipping policy and delivery time clearly stated on the website and the cost / YES ☐ / NO ☐
Credit card logos clearly visible / VISA / MasterCard
YES ☐ NO ☐ / YES ☐ NO ☐
Products/Service available for sale on website / Click here to enter text.
Payment type (pre authorized recurring/subscription fee, one-time payment, pay-per minute, pay-per download, etc) / Click here to enter text.
When does the payment take place (upon purchase, on delivery, upon download, etc)? / Click here to enter text.
Delivery time for goods/service (from purchase) / Over the Internet ☐ / 1-5 days ☐ / 6-13 days ☐ / >14 days ☐
Please specify market coverage, customers’ countries? Major countries where the customers come from / Click here to enter text.
Do you have an appropriate business license for your business (pharmaceutical licence, suppliers’ license, gaming license etc)? If yes please provide us with a certified copy / Click here to enter text
Your PCI DSS compliance Level (1, 2, 3, or 4) / Click here to enter text.
Payment Service Provider in use*
Company name / Click here to enter text.
Website / Click here to enter text.
Country / Click here to enter text.
Service provided (pls specify) / Click here to enter text.
PSP PCI DSS Level 1 compliance details / Registration number: Click here to enter text.
Expiry date: Click here to enter text.
Additional information / Click here to enter text.
*If any other PSPs than DalPay are in use then please provide us with the same information. We need to be informed about all companies involved in the payment process. If you do not currently accept ‘card not present’ or other online payments please leave this section blank.
Settlement Bank Account*Owner of account / Click here to enter text.
Bank name / Click here to enter text.
Bank details / Street address / Click here to enter text.
City / Click here to enter text.
Country / Click here to enter text.
Telephone / Click here to enter text.
Account number for each settlement currency**
Currency (i.e. USD) / Choose an item.
SWIFT code / Click here to enter text.
Account number / Click here to enter text.
IBAN number: / Click here to enter text.
Reference code (if needed) / Click here to enter text.
Currency i.e. (EUR) / Choose an item.
SWIFT/BIC code / Click here to enter text.
Account number / Click here to enter text.
IBAN number: / Click here to enter text.
Reference code (if needed) / Click here to enter text.
Currency (i.e. GBP) / Choose an item.
SWIFT/BIC code / Click here to enter text.
Account number / Click here to enter text.
IBAN number: / Click here to enter text.
Reference code (if needed) / Click here to enter text.
*if the company is not the beneficial owner of the bank account we need a confirmation letter signed by all parties and due diligence documents for the account owner. We provide you with the confirmation letter if needed.
**If more than three settlement currencies then please send detailed bank account information with this application
Required Due Diligence Documents*Documents sent with this application**
Certificate of Incorporation / ☐
Memorandum of Association or Articles of Association / ☐
Certificate of Shareholders issued by Company Registrar / ☐
Certificate of Directors issued by Company Registrar / ☐
Certified copy of beneficial owners/directors passport / ☐
Copy of utility bill for beneficial owners/directors / ☐
Annual report or balance sheet for the last fiscal year / ☐
Business plan (only for new companies) / ☐
Certificate of the PCI DSS compliance of the gateway / ☐
Previous acquiring report (at least 3 months prior this application) / ☐
Verification of bank account owner*** / ☐
Additional information? (please specify) / Click here to enter text.
*Please note that before the first settlement can take place we need to receive a certified copy of all these documents. First you can send them electronically to (with the Subject: Direct application/Company Name)
**Please note that if the documents are not in English we may request them to be translated by a verified translation agency.
***Verification of ownership of the bank account; a letter from the bank; a voided check; an account statement. If the owner of the bank account is different from the company, we need a signed letter that indicates that we are authorised to transfer the settlement to this account. We may also need further due diligence documentation on the bank account owner.