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BECOME A
MERCHANT
Please fill out the form to become a Merchant with us.
Please complete this
Form
for us!
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Company Name
*
Doing Business as
Primary Business Activity
*
Founding Date
*
Tax ID #
*
Company Registration #
*
Legal Representative(s)
*
Average Transaction Value (in BRL)
Monthly Total Processing Volume (in BRL)
Commercial Contact Name
*
Commercial Contact E-mail
*
Finance Contact
*
Finance Contact Email
*
Legal Contact
*
Legal Contact Email
*
Administrative Contact
*
Administrative Contact Email
*
Technical Contact
*
Technical Contact Email
*
Technical Contact Skype Address
Customer Service Contact (Website/Phone Number/etc.)
*
Customer Service Contact Email
*
Account Holder
*
IBAN / Account #
*
BIC / SWIFT Code
*
Beneficiary Bank
*
Branch #
*
In which currency would you like your settlements?
EUR
USD
BRL
CAD
GBP
CHF
AUD
In which currency will you send prices?
EUR
USD
BRL
Correspondent Bank
BIC/SWIFT code
Clearing Code
Merchant Shareholder/UBO Information. Please include: Name, Shareholder Tax ID #, Shares in %, Date of Birth, Mother's Full Name
*
Please include: Name - Shareholder Tax ID # - Shares in % - Date of Birth - Mother's Full Name -
Corporate Structure
If any of the UBO(s) are not directly shareholders of the Sub-Merchant, please provide a file outlining the corporate structure
PDF, JPG/JPEG, PNG, DOC, DOCX up to 25MB
Politically Exposed Person (PEP)
PEP
Could any member of the board/ other person within the management/ shareholder be considered a “politically exposed person” (PEP) under the third money laundering directive (2005/60), or related to such person, please describe the circumstances which constitute such status below. Please provide certified passport or national ID-card copies for all such people.
Soft descriptor (13 character limit)
*
URL(s)
Please include any other URL(s) for which you are intending to operate the payment services
End-User Customer Support Contact Email
*
Please include the email address via which users can reach your customer support in case of questions
Are you PCI compliant?
*
Yes
No
Server to Server or Hosted Checkout?
Server to Server
Hosted Checkout
What payment options are we servicing?
*
Local Debit Cards
Local Credit Cards
Boleto Bancário
Local Bank Transfer (incl. PIX)
Do you require local credit cards to be processed via 3DS 2.0?
*
Yes
No
Do you require tokenized payments for subscriptions or one-click payments?
Yes
No
Company Certificate of Registration
*
Company Certificate of Registration (or similar)
PDF or JPEG up to 25MB
Utility Bill
*
Utility Bill (of any sort), no older than three (3) months, showing Company Address, matching Company Certificate of Registration.
PDF or JPEG up to 25MB
Articles of Association
*
Articles of Association / Company By-Laws
PDF or JPEG up to 25MB
Power of Attorney
Power of Attorney (in case the Signee(s) is/are not nominated by the Articles of Association / By-Laws)
PDF or JPEG up to 25MB
Certified Passport Copies of Signee
*
Certified Passport Copies of Signee(s)
PDF or JPEG up to 25MB
Official Bank Statement
*
Official Bank Statement (on letterhead, if applicable stamped), no older than three (3) months, showing Company Name (as shown above) and the details for bank account(s) held by Merchant in relation to the service of epag. (Please note that if another company holds the bank account, please provide further explanations on this together with supporting documents)
PDF or JPEG up to 25MB
Certified Passport Copies of UBO(s)
*
Certified Passport Copies of UBO(s)
PDF or JPEG up to 25MB
Proof of domestic, registered addresses
*
Proof of domestic, registered addresses for all UBOs listed
PDF or JPEG up to 25MB
Supplementary Documentation
Please use the file upload to provide any supplementary documentation
PDF or JPEG up to 25MB
Submit
