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REAL ACCOUNT APPLICATION FORM

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Academic year: 2021

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To use the MasterCard Payment Gateway you must have a Merchant ID number for e-commerce with one of the Acquiring Banks that we connect to.

To use the MasterCard Payment Gateway Services Direct Debit service you must have an Originator ID number that has been issued by your Sponsoring Bank.

Please allow 10 minutes to complete this application. If you have any further enquiries please contact our Sales Team on 0870 72 74 761. Fields marked in BOLD are mandatory. We are unable to process your application if you send us incomplete information.

Please do not submit this form until you have a merchant ID Number / Originator ID Number. Fields marked in BOLD are mandatory

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2. CONTACT DETAILS

Company Name:

Trading as:

(If different from above)

Address:

Country:

Postcode:

VAT No: Registration No:

Are you an existing MasterCard Payment Gateway Services Customer?

YES NO Contact Name: Job Title: Work Telephone: Mobile: General Email: Technical Email: 1. COMPANY DETAILS

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4. SERVICES Contact Name: Telephone: Email: Address: Country: Postcode: 3. BILLING DETAILS

Please tick the Value Added Services that you require:

Real Time Fraud Screening 3-D Secure

Age Identity Verification Bin Range Restriction Ceiling Limits

FRAUD PREVENTION

Payment Tokenization (Pre-Registered Card) Card Tokenization

TOKENIZATION SOLUTIONS

Credit / Debit Card Continuous Authority Direct Debit Continuous Authority

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5. DIRECT DEBIT & DIRECT CREDITS 4. SERVICES (CONT.)

YES, I require the Direct Debit Service YES, I require the Direct Credit Service American Express

Corporate Purchasing Cards Visa Electron

Laser Diners

ADDITIONAL CARD TYPES

Transax Cheque Guarantee Batch Processing

Split Shipment

Chargeback Management e-Wallet Solutions

Dynamic Currency Conversion

OTHER SERVICES

e-Vouchers

Online cash transactions

PREPAY SOLUTIONS Originator ID No (OIN): Sponsoring Bank: OIN Type:

AUDDIS AUDDIS PAPERLESS Please supply one e-mail address in which the electronic notification(s) should be sent. Email:

To ensure that you receive electronic notification of failed DD setups, please make sure you have completed section 6 of the BACSTEL IP form from your sponsoring bank.

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Please enter your Merchant ID Number(s), given to you by your acquiring bank, for e-Commerce and/or Mail / Telephone Order (if applicable). Enter the 3 digit currency code in the boxes below that you wish to trade and settle in.

Please confirm whether your MID is being used for Gaming authorisations (SIC: 7995)

YES NO

Please confirm which country your MID is registered to?

6. MID REQUIREMENTS

MERCHANT

ID NUMBER MID TYPE TRADE IN SETTLE IN

ACQUIRING BANK MERCHANT CATEGORY CODE (MCC) COUNTRY CODE Further requirements:

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7. MASTERCARD PAYMENT GATEWAY SERVICES ANNOUNCEMENTS

6. MID REQUIREMENTS (CONT.)

MasterCard Payment Gateway Services announcements are sent in the event of any changes occurring that may affect the service you receive from MasterCard Payment Gateway Services, its partners or acquiring banks used. This will include details of system status updates and scheduled maintenance notifications.

It is recommended that you set up a mailing list at your company of the form: 'mpgs@yourcompany. com' with all interested parties subscribed. This ensures that announcements will be received even if a key member of staff is not available.

This information will be used solely for the

purpose of informing you of important operational information, and will not be used for marketing purposes.

YES I would like to receive MasterCard Payment Gateway Services announcements to the following E-mail address:

NO I do not wish to receive MasterCard Payment Gateway Services announcements

Bank account in which the monies are to be settled. Bank Name: Bank Address: Sort Code: Account Number: Purchase Order:

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8. TECHNICAL INFORMATION

From which IP Address will you submit transactions to MasterCard Payment Gateway Services?

E-Commerce website:

Description of products/services you will be selling via the account:

9. MASTERCARD PAYMENT GATEWAY SERVICES REPORTING SYSTEM

Please supply details of the person who will administer MasterCard Payment Gateway Services Reporting Accounts for your organisation.

IP Address to access Reporting:

Reporting Username:

(Alphanumeric Characters only, max 20) Forename: Surname: E-mail Address: Telephone Number:

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11. CONFIRMATION 10. ADDITIONAL INFORMATION

How did you find MasterCard Payment Gateway Services?

From existing customer (*) Bank recommendation (*) IBS Software Services (P) Ltd Telesales / Sales Call

Search Engine / website Reseller (*)

Other

If other or marked (*) please specify

Your Comments:

Please do not submit this form until you have a Merchant ID Number.

I hereby declare the above information to be true and complete

References

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