From Idea to Action

~ The Order ~

Please note:

Complete and correct information is required to prepare the contract documents for our acquirers, banks, and payment service providers.
We therefore ask you to complete this form carefully and conscientiously.

Subsequent changes to previously issued documents can generally only be made through a new order or a complete re-draft of all contract documents.

With your support, we ensure that the process can be implemented smoothly, efficiently, and without delays for you.


Contractual partners with multiple locations should enter the address of their registered office and add the address of any additional business locations (if any) with their addresses here or attach them in a separate list. All fields applicable to the contracting partner must be completed.

General information and self-disclosure

Company name *

Legal form AG Association Civil law association e.V. eG Einfache Gesellschaft Einzelunternehmen EIRL e.K. Entrepreneurial company EURL GbR General partnership Genossenschaft GmbH GmbH & Co.KG Juristische Person des öffentlichen Rechts KG KGaA Kollektivgesellschaft Kommandit-Aktiengesellschaft Körperschaft des öffentlichen Rechts Limited partnership Limited partnership with a limited liability company as general partner Ltd. OHG PartG Plc. Registered association Registered cooperative SA S.A. Sàrl SARL SAS SASU Foundation UG Verein Other

Owner: Last name, First name(s) (all) (only for sole proprietorships and limited liability companies)

Street *

House number *

Line 1

Line 2

Country * Andorra Belgium Germany Estonia Finland France Greece Ireland Italy Croatia Latvia Liechtenstein Lithuania Luxembourg Malta Monaco Netherlands Austria Portugal San Marino Slovakia Slovenia Switzerland Spain Cyprus

Postal code *

City *

e-mail address *

Telephone number *

website

Company's year of establishment *

Registration court *

Registration number *

VAT identification number *

Creditor ID

Company's main industry *

Industry of acceptance point *

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Please select as appropriate:

Transparency Register (Germany only) *

Legal entities under private law and registered partnerships (e.g., GmbH, GmbH & Co. KG; eGbR, but not GbR or public-law foundations) must report certain information about their beneficial owners to the Transparency Register.

  Entry in the Transparency Register exists; The contracting partner confirms that it has registered with the Transparency Register within the meaning of Sections 18 et seq. of the German Money Laundering Act (GwG) and has reported the required information about the beneficial owners to the Transparency Register. The contracting party will promptly submit proof of registration with the Transparency Register, which contains information on the beneficial owners (e.g., a screenshot of the registration, a printout of the registration page). By submitting the documents, the contracting party confirms that the information provided is correct and up-to-date.

  The contracting party is not subject to any Transparency Register obligations (e.g., because the contracting party is a natural person, a partnership under civil law, or a legal entity under public law).

Acting on its own account *

  The contracting party is acting on its own account.

  The contracting party is acting on behalf of another party. Further information on the beneficial owner is required for this purpose.

Does the company offer subscriptions? *    Yes    No

Is payment acceptance used for advance payments on goods/services? *    Yes    No

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The contracting party is a natural person (sole proprietorship, including freelancers, registered merchant).

Since you have selected a sole proprietorship, please provide the owner's personal information.

First name(s) *

Last name *

Date of birth *

Place of birth / Country of Birth *

Nationality *

Type of ID presented *
(For non-EU/EEA citizens, a copy of the identification documents and residence permit is required)

Identity Card

Passport

Other:

ID Number *

Issuing Authority *

Expiration Date *

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The contracting party is a legal entity or partnership (e.g., GmbH, AG, OHG, KG, GmbH & Co. KG, GbR, etc.)

Please enter the relevant company information here:

Names of the members of the representative body or legal representatives
Member(s) of the representative body or legal representative is/are a natural person(s) *

First name(s)

Last name

Sole Power of Representation

Joint Power of Representation

Member(s) of the representative body or legal representative is a legal entity or partnership

Name / Company Name *

Legal form *

Registration court *

Street / House number *

Postal code / City, Country *

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Information on the Beneficial Owner *
The beneficial owner within the meaning of the Money Laundering Act is the natural person who owns or controls the The ultimate contractual partner, or the natural person at whose instigation a transaction is ultimately carried out or a business relationship is ultimately established. For natural persons as contractual partners, this is the case, for example, if the contractual partner acts on behalf of third parties. For legal entities or partnerships as contractual partners, this is the case if a natural person, directly or indirectly, holds more than 25% of the capital shares or voting rights or exercises control in a comparable manner.

The following fictitious beneficial owners of the contractual partner exist

First name(s), Last name

Date of birth

The following beneficial owners of the contractual partner exist

First name(s), Last name

Date of birth

If the representative of the contracting partner is a legal entity or a registered partnership, any natural person who holds more than 50% of the capital shares or voting rights in the representative company or who exercises control in a comparable manner is a beneficial owner.

The following notional beneficial owners of the legal representative of the contracting partner exist (only if the representative is a legal entity or partnership):

First name(s), Last name

Date of birth

The following beneficial owners of the legal representative of the contracting partner exist (only if the representative is a legal entity or partnership):

First name(s), Last name

Date of birth

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Politically Exposed Person *
A politically exposed person (PEP) is any natural person who holds or has held a high-ranking important public office at the international, European, or national level, or who holds or has held a public office below the national level with comparable political importance.

It is confirmed that neither the contracting partner nor any beneficial owner of the contracting partner is a politically exposed person.

It is confirmed that the contracting party and/or a beneficial owner of the contracting party is a politically exposed person.

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Representing Person *
A (natural) person representing the contracting party is the person who claims to act on behalf of the contracting party (including members of the representative body or legal representatives). If more than three people are representing the contracting party, please add this as an attachment.
Only the person(s) representing the contracting party who will sign the service application should be listed here.

1. Representing Person

First name(s), Last name *

Date of birth *

Place of birth / Country of Birth *

Nationality *

Private Address *

Type of ID presented *
(For non-EU/EEA citizens, a copy of the identification documents and residence permit is required)

Identity Card

Passport

Other:

ID Number *

Issuing Authority *

Expiration Date *

Authority to Represent *

Sole Power of Representation

Joint Power of Representation

+ Additional person to appear

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Access Data and Merchant Statement *
Payment: Sales are credited weekly in euros by default. Merchant Statement: You will receive your electronic merchant statement with the payment. You will receive the statement (please select)

in the service portal for retrieval

electronically to the email address specified below

Please enter your email address for the merchant statement here:

Note: This email address also serves as your user ID in the service portal.

Name to be shown on the cardholder's card statement (max. 22 characters): *

Terminal location (only required for acquiring with third-party terminals):

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Account details / SEPA / Credit and direct debits *
Bank details of the contractual partner for credit and direct debits:

Name of the account holder *

Address *

Postal code, City, Country *

Account type

Name of the account-holding institution *

IBAN *

BIC *

Credit/Refund

Direct Debit

*Required

I agree to the transfer, use and processing of my data in accordance with the Privacy Policy. I also agree to be contacted to respond to my inquiry. *

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