Thetabiz™ Offshore Services

Company name

Street address

Postal code

City

Country

Company type Corporation Limited liability company Financial institution Bank Self employed

Registered company capital

Country and city of registration

Company number

If there is no company number, please write so.

Year of incorporation

If self employed or unincorporated, please state the year of business begin.

Title Mr. Mrs. Ms. Dr.

First name

Last name

Position

E-mail of manager

Phone

Fax

Mobile phone

Commercial or trade name

Street

Postal code

City

Country

E-mail

Phone number

Fax

Mobile phone

Title Mr. Mrs. Ms. Dr.

First name

Last name

E-mail

Phone number

Fax

Mobile phone

URL of your website

Languages on the website

Are you new in business? Yes No

Date when you have started website activity

Methods of payment used until now

Reasons for change

Monthly percentage of your previous chargeback

Description of goods and/or services marketed

Tell us in which countries do you mostly sell your goods or services

Be very descriptive and tell us if you sell locally; then to which countries in Europe, worldwide; do you sell to United States or to Asia or whereever.

URL of your general sale conditions

This URL will be verified and its content attached to your application. Without your general sale conditions or if they are incomplete, your site cannot be validated. If you don't have it, ask us to help you make the General Sales Conditions.

Please list all of the website URL’s that you require a merchant account

Permanent username for monitoring of the content

In addition, for adult sites, you must provide permanent user name for unrestricted access so that underwriting and risk can monitor your site at any time for illegal or highly inappropriate content.

Permanent password for monitoring of the content

In addition, for adult sites, you must provide a permanent password for unrestricted access so that underwriting and risk can monitor your site at any time for illegal or highly inappropriate content.

Estimated monthly turnover forecast

Include the currency like USD, EUR or other.

Which currencies do you require?

State the average sales amount in each currency, total monthly turnover for each currency and number of monthly transactions in each currency USD Average sales amount: EUR Average sales amount: GBP Average sales amount: USD Total monthly turnover: EUR Total monthly turnover: GBP Total monthly turnover:

Account name

Address of account

Account number

Bank's name

Bank's address

Clearing (for Switzerland only)

ABA routing (for US only)

SWIFT code

IBAN