MERCHANTS REGISTRATION

MERCHANTS
REGISTRATION

Prosecure Payment registration
Stage 1 of 3
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Company Headquarters :
Company Name :
Postal address :
Post code :
City :
Country :
Company status :
Capital :
Certificate of incorporation (RC) of (town):
Certificate (RC) no. :
Year of incorporation :
Company manager :
Title :
Name :
First name :
E-mail address :
Telephone :
Fax :
Mobile :
Commercial address :
This information will be given to your customers at the time of payment for eventual contacts. (Don’t fill this part if the commercial information is the same as the information on company HQ)
Commercial name :
Postal address :
Post code :
City :
Country :
E-mail address :
Telephone number :
Fax :
Mobile :
Administrator of ProSecure Payment operations :
This is the person who will receive notification of ProSecure transactions by e-mail. Other e-mail addresses may be added from the Administration Back Office. (Don’t fill this part if the operations administrator is the company director)
Title :
Name :
Firstname :
E-mail address :
Telephone :
Fax :
Mobile :