Merchant Agreement

Natural Person

Data Contract Partner

First Name *

Last Name *

Street *

House Number *

ZIP-Code *

City *

Country *

Merchant Master Data

Salutation *

First Name *

Last Name *

Additional Name

Street *

House Number *

Additional Address

ZIP-Code *

City *

Country *

Day of Birth *

Place of Birth *

Nationality *

ID / Passport Number *

Issuing Authority *

Issuing Date *

Valid Until *

Mobile Phone

eMail Address *

Back to Step 1

Data Contact Person

Contact Management

First Name

Last Name

Mobile Phone

eMail Address

Contact Financial & Bookkeeping

First Name

Last Name

Mobile Phone

eMail Address

Contact Technical & Development

First Name

Last Name

Mobile Phone

eMail Address

Contact Customer Support

First Name

Last Name

Mobile Phone

eMail Address

Back to Step 2

Bank Connections

Bank Account Owner Payouts

First Name *

Last Name *

Street *

House Number *

ZIP-Code *

City *

Country *

Bank Account Payouts

Bank Name *

ZIP-Code *

City *

Country *

Account Number *

IBAN *

BIC / SWIFT *

Bank Acount Owner SEPA-Direct-Debit-Mandate

First Name *

Last Name *

Street *

House Number *

ZIP-Code *

City *

Country *

Bank Acount SEPA Business to Business Direct Debit Mandate

Bank Name *

ZIP-Code *

City *

Country *

Account Number *

IBAN *

BIC / SWIFT *

Back to Step 3

Online Payment – Billable Websites

Wares and / or Services

Contract Type *

Business Type *

Recurring Services (e.g. Memberships, subscriptions etc.) *

Minimum Ticket Size / Currency *

Maximum Ticket Size / Currency *

Average Ticket Size / Currency *

Current turnover for the running business year / Currency *

Planned turnover for the next business year / Currency *

Turnover last business year / Currency *

Monthly number of single transactions *

Number of Chargebacks SPEA Direct Debit for the last 6 months *

Number of Chargebacks Credit Cards for the last 6 months *

Delivery countries in percent *

Processing History exists with a different payment provider *

Current Payment Provider

Reason for Payment Provider Change

URL’s, Websites, to be billed *

I declare and affirm explicitly that I've read, understood and accepted the terms and conditions T&C and the currently valid conditions (fees & expenses). Furthermore, I certify that all information provided on this form have been made to the best of knowledge and belief and match the truth. I acknowledge that willfully made false statements may result in an immediate dismissal or non-inclusion of the business relationship with Paycific.

Back to Step 4