Terminal Application – Chip and Pin Direct

Full Name

Phone Number

Email Address

Business Name

Trading Name*

Company Reg. No

VAT. No

Business Description

Date of Incorporation

Trading Start Date

Trading Address*

County*

City*

Post Code*

Bank Name

Account Name

Sort Code

Account Number

I accept the Direct Debit Guaranteed ( this will be sent to your email when your application has been acceptanted)

Full Name

Date of Birth

Nationality

Current Address

Post Code

Time at Address

Position in Company

Email Address

Phone Number

Time in Company

Have you ever been Bankrupt or associated with Voluntary Arrangement?

Trading Address Photos. Photos of your business from inside the business showing the counter/reception and photos from outsitde of your trading business address showing signage with your business name. (Please attach files )

ID Card, Driving Licence or Passport. Valid Government ID Card. Front and Back side. Original ID Card. Full photo. All parts of the ID card must be shown. The four corners of the ID card must show on the photo. ID must be original and valid. ID card must be very clear. (Please attach file) *

I hereby agree that the information given is true, accurate and complete as of the date of this application submission. **

Chip and PIN Direct is more than just a payment provider; we are your trusted partner in navigating the digital landscape. Our unwavering commitment to your security and our relentless pursuit of innovation set us apart. Join us on this journey as we redefine the way you think about secure payments.

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