Merchant - Polydirection

Merchant

Contact information

Company name

Registration number

Registration date

Legal Address

Address line

City

State/Province/Region

Postal code

Country

Physical address

Address

Country

Phone *

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Web-site

Detailed business description

Does your business require licensing?

License number, issuing institution and issuing date

Purpose of account opening

Information about customers authorized person

Authorized Person No.1

Authorized Person No.2

Name, Surname *

Date of Birth

Month

Day

Year

Place of Birth *

Residence *

City

ZIP code

Country *

Identification document information

Type

1 person

Type

2 person

Number

1 person

Number

2 person

Date of issue

1 person

Date of issue

2 person

Date of expiry

1 person

Date of expiry

2 person

Citizenship *

2 person

Are you US person? *

Are you PEP person? *

Information about customers beneficiary

Beneficiary No. 1

Beneficiary No. 2

Name, Surname *

Month

Day

Year

Place of Birth (Person One) *

Place of Birth Person 2 *

Share in company %

Residence address *

City

ZIP code

Country *

Identification document information

Type

1 person

Type

2 person

Single Line Text

Number

2 person

Date of issue

1 person

Date of issue

2 person

Date of expiry

1 person

Date of expiry

2 person

Citizenship *

1 person

Citizenship *

2 person

Are you US person? *

1 person

Are you US person? *

2 person

Are you PEP person? *

1 person

Are you PEP person? (copy) *

2 person

Phone

Contact information

Legal Address

Physical address

Information about customers authorized person

Authorized Person No.1

Authorized Person No.2

Date of Birth

Identification document information

Information about customers beneficiary

Beneficiary No. 1

Beneficiary No. 2

Identification document information

Part A : Banking

Financial information

Your major business partners list

Financial information

Client’s geography

Cardholders data

Processing information

Customer’s confirmation