Application for a Merchant Facility - FLAT RATE.

What product are you applying for?

Select an option from the dropdown menu

Business Details:

Merchant Trading Name:

Please fill out this field

(Name that appear above the door/ t/a "xxxxxxxxxxxx". Should be the same as the Name to Appear on Receipts)

Legal Entity Name:

Please fill out this field

Write the full Legal Entity Name e.g.: John Smith or ABC Pty Ltd or John Smith as trustee for the Smith Family Trust.
Don't write the Trading Name in this field.
Don't include titles eg Dr, Mr, Ms in the legal entity name.

Name to Appear on Receipt:

Please fill out this field

Customers should be familiar with this name if they see it referenced on their receipt.
This should be the name above the door or Merchant Trading name.
Max 22 Characters. Special characters that are NOT permitted are # and ^.

Registered Business Details (“trading as xxxxxx”)

Is the Business Name Registered?

Select an option from the dropdown menu

(tap and select)

Full Registered Business Name: (as per the registered business name that appears on the ASIC & Business Name Search)

ABN:

Principle Place of Business Address:

Suburb:

State:

Postcode:

Please enter exactly 4 digits

Legal Entity Details: (select and complete the details for the legal entity type applicable to your business)

Legal Entity Type:

Select an option from the dropdown menu

Registered Office Address:

Suburb:

State:

Postcode:

Please enter exactly 4 digits

Full Company Name:

ACN:

ACN must be between 9 and 11 characters

Trust Name:

Relationship Manager Name

Please fill out this field

(MANDATORY FIELD. If this is a Not relationship managed customer, please type N/A)

Is this a change of ownership?

Select an option from the dropdown menu

Old terminal collection:

Settlement Account Details -All Merchant Facilities

Please provide BSB & Account Number

Please fill out this field

Account number must be 6-9 characters

Account Name:

Please fill out this field

Enter the Acc. Name for the Acc. the merchant would like the funds to be settled.
Acc. Name should resemble the merchant facility name i.e the Legal entity/Trading name.

Is the Fee/Rebate Account different from the settlement account?

Select an option from the dropdown menu

Please proceed to check note below

Please fill out this field

Account number must be 6-9 characters

Account Name:
(Fee/Rebate Account)

Please fill out this field

Business Contact Details:

The contact person must be authorised on this Facility, available to be contacted by Bambora and available on-site for installation (where applicable). They will be responsible for selecting the Merchant password. Once it has been selected, it may only be changed by those who are authorised for FULL Merchant Facility access.

Contact Name:

Please fill out this field

Phone:

Phone numbers are 10 digits long

Include the area code

Mobile:

Start with +61 followed by 9 digits

Start with +614******** e.g. +61412345678

After Hours:

Phone numbers are 10 digits long

Do you wish to receive electronic communications?

Select an option from the dropdown menu

If YES - Ensure customer is aware of the note below.

By selecting yes, you agree to receive merchant statements, letter of offer, terms and conditions, merchant user guide and or any other contract documentation or correspondence relating to your Merchant Facility with Suncorp electronically to the email address specified in this Form, unless otherwise agreed.

E-mail:

Please enter a valid email in the format example@domain.com

Communication Password:

Password must be 6-10 characters long, contain only UPPERCASE letters and/or DIGITS, and not be a numeric code that represents your DOB, your driver's license #, or a recognizable part of your name

Must be 6-10 characters long.
Letters are always in CAPITALS and no case sensitive.
It cannot be:
* A numeric code that represents your DOB
* You driver's license #
* A series of consecutive or the same Number
* A recognizable part of your name

Website:

Please enter a valid website URL starting with 'www', or with 'http://' or 'https://'. Example: https://www.example.com or www.example.com

Trading Hours and Settlement Preferences:

Trading Hours:

Earliest: 24 hour clock:

Hours:

Select an option from the dropdown menu

Minutes:

Select an option from the dropdown menu

Latest: 24 hour clock:

Hours:

Select an option from the dropdown menu

Minutes:

Select an option from the dropdown menu

Settlement Options:

Select an option from the dropdown menu

Settlement Time:

(Must be between 00:01 and 21:00 AEST Brisbane time)

Hours:

Minutes:

Business Type and Location:

Merchant Category Code (MCC):

Start typing or select an option from the dropdown menu

Nature of Business (please provide details)

Please fill out this field

This needs to reflect what the merchant does/sells.
Don't use the Name to Appear on Receipt.
e.g. Zarraffas is the trading name not the nature of business.

Business/Site Address (where Merchant Facility is located)

C/o or Building

Street No. & Name

Please fill out this field

Enter the full physical address of the building including Street Number and Name.
The terminal will only be delivered to this address.

Suburb/Town

Please fill out this field

State:

Select an option from the dropdown menu

Postcode:

Please enter exactly 4 digits

Is the Postal address different from Business/Site Address?

Select an option from the dropdown menu

Postal Address (If different from Business/Site Address)

C/o or Building

Street No. & Name

Please fill out this field

Suburb/Town

Please fill out this field

State:

Select an option from the dropdown menu

Postcode:

Please enter exactly 4 digits

Terms of Trade:

How long has business been established and registered for GST?

Select an option from the dropdown menu

Does your business offer goods or services on a trial basis where credit card details are recorded and used to process payment at the end of the trial?

Select an option from the dropdown menu

What is the number of days between receiving payment, and delivery of goods/services?

Please fill out this field

EFTPOS

EFTPOS Terminal Requirements

Does your terminal have HealthPoint?

Select an option from the dropdown menu

Does your terminal have Medicare?

Select an option from the dropdown menu

How many terminal(s) are needed?

GPRS 4G:

WIFI:

Broadband: (Required if using Healthpoint)

SIM Provider (GPRS terminals only)

Template Type:

Select an option from the dropdown menu

Choose N/A if applying for Integrated POS.

Software Package:

Select an option from the dropdown menu

Choose N/A if applying for Integrated POS.

HealthPoint ID: For Merchants with HealthPoint software a HealthPoint ID must be provided for each terminal One HealthPoint ID is required for each physical terminal.
If the merchant has requested more than 2 terminals place additional ID's in the Sales Consultant Comments field.

I/We authorise the nominated Value Added Service (VAS) Providers to contact me/us in the future.

Select an option from the dropdown menu

Multi Merchant: Will multiple merchants need to use this facility? (e.g. multiple doctors at a surgery, hairdressers at a salon)

Select an option from the dropdown menu

Integrated POS

Integrated Terminal Requirements

Terminal Rental Fee per Terminal and Terminal requirements

How many terminal(s) are needed?

Countertop Integrated Terminals
(Broadband Communications):

Mobile Integrated- Broadband Comms
(Traditional On Premise POS):

Mobile Integrated-WIFI Comms
(Cloud Based POS):

Template Type:

Select an option from the dropdown menu

Choose N/A if applying for EFTPOS.

Software Package:

Select an option from the dropdown menu

Choose N/A if applying for EFTPOS.

Software Vendor Name:

Select an option from the dropdown menu

Type N/A if applying for EFTPOS.

Use existing Linkly user name and password?

Please fill out this field

Choose N/A if applying for EFTPOS.

Existing TID -Terminal Identification Number:

Input must be exactly 8 characters in length

Number of swivel bases required:

Please enter a valid input containing only letters e.g. ONE

Car Charger

Number of Car Charger(s) required?

Please enter a valid input containing only numbers

Financial Data and Fees:

Refund limit and count:

Refund $ limit: (per transaction)
If not required, input must be 0.
Determine the refund limit by multiplying the average transaction by 1.5
Any refund values greater than $250 (inc Medicare) will require DCA approval and further justification may be required from the approver.

Please enter a valid input starting with Dollar Sign ($) and following by numbers

Reason: (Please provide justification if refund amount limit is greater than $250)

Refund count limit: (# of refund transactions per day)
If not required, input must be 0.

Please enter a valid input containing only numbers

Reason: (Please provide justification if refund count limit is greater than 5)

Average Annual Figures

Proposed Card Turnover (annual):

Please enter a valid input starting with Dollar Sign ($) and following by numbers

Merchant Pricing

Promotion Code: If applicable, provide promotion code or ALNA Member Number.

Pricing

Fees (All fees and charges are exclusive of GST)

Merchant Service Fee (as a % of Credit Card transaction value, charged at the end of each calendar month):

Debit Card Transaction Fee (per Debit Card transaction, charged at the end of each calendar month):

High Risk Comments Choose "Merchants accepts payment at completion of work." to proceed with application.

Personal Details (Business Owners/Directors)

Please capture all applicants (Sole Traders, Partners, Directors, Trustees, Members of an Association, Business Owners and Committee Members) details below. All Business Owners/Directors shall be provided Full Access to the Merchant Facility including the ability to perform refunds, access and change the refund password, access information about the merchant facility, request changes and terminate the Merchant Facility.

If you’re a company, a minimum of 2 Directors or any 1 Director and Company Secretary must sign. All partners of a partnership must sign

How many people are signing this form?

Business Owner/ Director 1

Full Name:

Please fill out this field

Position:

Please fill out this field

Date of Birth:

Please enter DOB in the format DD/MM/YYYY (e.g. 24/06/1990)

Email address:

Please enter a valid email in the format example@domain.com

Residential Address

C/o or Building

Street No. & Name

Please fill out this field

Suburb/Town

Please fill out this field

State:

Select an option from the dropdown menu

Postcode:

Please enter exactly 4 digits

Is the Postal address different from Residential Address?

Select an option from the dropdown menu

Postal Address

C/o or Building

Street No. & Name

Please fill out this field

Suburb/Town

Please fill out this field

State:

Select an option from the dropdown menu

Postcode:

Please enter exactly 4 digits

Phone (Work):

Phone number must 10 characters

Phone (Home):

Phone number must 10 characters

Mobile:

Phone number must 10 characters

Business Owner/ Director 2

Full Name:
Put N/A if not applicable

Please fill out this field

Position:

Please fill out this field

Date of Birth:

Please enter DOB in the format DD/MM/YYYY (e.g. 24/06/1990)

Email address:

Please enter a valid email in the format example@domain.com

Residential Address

C/o or Building

Street No. & Name

Please fill out this field

Suburb/Town

Please fill out this field

State:

Select an option from the dropdown menu

Postcode:

Please enter exactly 4 digits

Is the Postal address different from Residential Address?

Postal Address

C/o or Building

Street No. & Name

Please fill out this field

Street No. & Name

Please fill out this field

Suburb/Town

Please fill out this field

State:

Select an option from the dropdown menu

Postcode:

Please enter exactly 4 digits

Phone (Work):

Phone number must 10 characters

Phone (Home):

Phone number must 10 characters

Mobile:

Phone number must 10 characters

Business Owner/ Director 3

Full Name:
Put N/A if not applicable

Please fill out this field

Position:

Please fill out this field

Date of Birth:

Please enter DOB in the format DD/MM/YYYY (e.g. 24/06/1990)

Email address:

Please enter a valid email in the format example@domain.com

Residential Address

C/o or Building

Street No. & Name

Please fill out this field

Suburb/Town

Please fill out this field

State:

Select an option from the dropdown menu

Postcode:

Please enter exactly 4 digits

Is the Postal address different from Residential Address?

Select an option from the dropdown menu

Postal Address

C/o or Building

Street No. & Name

Please fill out this field

Suburb/Town

Please fill out this field

State:

Select an option from the dropdown menu

Postcode:

Please enter exactly 4 digits

Phone (Work):

Phone number must 10 characters

Phone (Home):

Phone number must 10 characters

Mobile:

Phone number must 10 characters

Business Owner/ Director 4

Full Name:
Put N/A if not applicable

Please fill out this field

Position:

Please fill out this field

Date of Birth:

Please enter DOB in the format DD/MM/YYYY (e.g. 24/06/1990)

Email address:

Please enter a valid email in the format example@domain.com

Residential Address

C/o or Building

Street No. & Name

Please fill out this field

Suburb/Town

Please fill out this field

State:

Select an option from the dropdown menu

Postcode:

Please enter exactly 4 digits

Is the Postal address different from Residential Address?

Select an option from the dropdown menu

Postal Address

C/o or Building

Street No. & Name

Please fill out this field

Suburb/Town

Please fill out this field

State:

Select an option from the dropdown menu

Postcode:

Please enter exactly 4 digits

Phone (Work):

Phone number must 10 characters

Phone (Home):

Phone number must 10 characters

Mobile:

Phone number must 10 characters

Sales Consultant Comments:
Add comments you have about the application

Application Completed by:

Suncorp Contact:
Sales Agent Name

Application for a Merchant Facility - FLAT RATE.

Business Details:

Business Details:

Registered Business Details (“trading as xxxxxx”)

Legal Entity Details: (select and complete the details for the legal entity type applicable to your business)

Settlement Account Details -All Merchant Facilities

Settlement Account Details -All Merchant Facilities

Business Contact Details

Business Contact Details:

Trading Hours and Settlement Preferences

Trading Hours and Settlement Preferences:

Earliest: 24 hour clock:

Latest: 24 hour clock:

Settlement Time:

Business Type and Location

Business Type and Location:

Business/Site Address (where Merchant Facility is located)

Postal Address (If different from Business/Site Address)

Terms of Trade

Terms of Trade:

EFTPOS

EFTPOS

EFTPOS Terminal Requirements

Integrated POS

Integrated POS

Integrated Terminal Requirements

Car Charger

Financial Data and Fees

Financial Data and Fees:

Fees (All fees and charges are exclusive of GST)

Personal Details (Business Owners/Directors)

Personal Details (Business Owners/Directors)

Residential Address

Postal Address

Residential Address

Postal Address

Residential Address

Postal Address

Residential Address

Postal Address

Sales Consultant Details