Pre-Qualify Application

TELL US ABOUT YOUR BUSINESS

To help us offer the best payment solutions for your business, please provide us with the below information about your business.

Are you currently with a payment gateway provider?*

Who is your current payment gateway provider?*

Other (please specify)

» Business Information

Business Name*

Trading Name

Please complete if not the same as your business name.

Type of Entity

ABN*

Are you registered for GST?

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Website

Website/s*

What is the nature of your business?*

Other (please specify)

Do you have an ecommerce store?

When did you start trading?*

» Business Address

Street Address*

Suburb/City*

State

Postcode*

Country

» Your Contact Information

First Name*

Surname*

Primary Contact Email*

Primary Contact Phone*

» Payment Solutions

What Payment Solution does you business need?

Debit and Credit Card Processing
Direct Debit and Direct Credits

How will you use our Payment Solutions?

If applicable, which shopping cart integrations do you need?

Other (please specify)

What is your estimated delivery time for goods/services to customers?*

Other (please specify)

» Your Business Turnover

Estimated Annual Sales*

Average sales value per transaction*

Projected sales value by card*

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Terms & Conditions*

I agree that additional fees will be incurred for refunds, chargebacks and other services that you receive from latpay. Our Standard and Enterprise rates are based on an 80/20 ratio of standard consumer cards to business, premium and international. An additional 1% will apply to business, premium and international cards. A higher fee may also apply to High-Risk businesses. Prices quoted exclude GST. I also agree that upon submission of this application, latpay may contact me to discuss my requirements and upon successful compliance review an agreement with latpay may be completed.

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Email

This field is for validation purposes and should be left unchanged.

TELL US ABOUT YOUR BUSINESS

TELL US ABOUT YOUR BUSINESS

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