Partner Registration Form

DBA Name *

Legal Name *

Name of Principal (s) *

Country

Year of company were established?*

Country Registered*

Physical Address*

Email*

Website*

Phone Number*

Type of Business *

Sole Proprietorship
Partnership General / Limited
Limited Liablility
Tax Exempt/Non-Profit
Other

How did you here about us? *

How long have you been in the Payment Industry *

What business categories does your organization target ? *

High Risk Businesses Low Risk Businesses Retail Merchants European Merchants ROW Merchants

What regions do you market?

Asia Africa Canada Europe Middle East Latam South America United States United Kingdom

Are you currently providing eCheck Processing? *

Are you currently providing Credit Card Processing ? *

What payment method your businesses will need in percentage? *

Point of Sale %

Virtual Terminal %

Ecommerce %

Total %

Whats your merchant portfolios turn over monthly? *

Projected Numbers of Merchant Applications per Month? *

Which virtual terminal you prefer for the businesses? *

NMI Authorize.net Other

How many sales agent work for you? *

0-10
11-25
25-50
50-
100+

Could you please provide some additional detail on what your company provides to merchants ?

Code of Ethics *

I agree to the following Code of Ethics and hereby indemnify Binary Gateways harmless from any damages, liability or expenses for any violations of this code of ethics by me or any sub-representative I may employ:

No false promises or claims that are not indicated on the merchant Processing Agreement will be made;
We will not make promises of payment for prior lease obligations or fee obligations for previous processing obligations in order to induce the applicant to sign an Agreement, unless those payments are actually made on the merchant’s behalf;
I will always provide merchants with all pages of the Agreement upon receipt of their signature;
All fees will be disclosed to the merchant prior to obtaining signature;
I will not have the merchant sign any pages of the agreement that have not been completely filled out;
I will not submit an agreements to Binary Gateways that have been altered after the customer has executed the Same, without written authorization from the merchant;
I will abide by all Federal, State and local laws, Visa/MasterCard Rules and Regulations, regulatory Agencies and Member Bank and Binary Gateways’s policies and procedures;
I will not accept monies from any merchant for services that I have not invoiced or provided;
I will not initiate any transactions in a merchant’s credit card equipment other than test transactions.

Please acknowledge receipt and understanding of the above stated compliance and code of ethics agreement and return with the Partnership Agreement.