Business Name (DBA)

Legal Business Name (Registered Name)

Nature of Business

Business Street Address

Unit

Postal Code

Province
ABBCMBNBNLNTNSNUONPEQCSKYT

Business Phone

Email Address

Legal First Name

Legal Last Name

Date of Birth

Home Address

Annual Company Sales

Monthly Card Sales

Average Transaction (ATS)

Highest Transaction (HTS)

Select your hardware
NEWLAND N950 – $24.95POYNT C – $39.95AXIUM DX8000 – $0Sales Team

Pricing Type
FLAT RATE 2.25%SURCHARGING (QC Prohibited)Sales Team

Picture of Valid ID (Health Card is not Accepted)

Void Cheque or Bank Slip of Business bank account

Article or Certificate of Business

Sales Rep ID (optional)

Additional Comments (optional)

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