OffshoreSimple.com

Merchant Application

Please complete for the form below and a member of our business development team will contact you shortly:

We mainly focus on dealing with new or existing online gaming, adult website and online pharmacy merchants. Also, it is hardly for us to deal with the clients whose monthly turnover is under $20,000
(even if it is estimated volume).

Items marked with * are required.

Company Name *
Contact Name *
Email *
Telephone *
Address
Post Code / ZIP
Country *
Nature of your business * Max 50 Words
URL
Business Type		European Incorporation
Country of Incorporation *
Current Processor

	Banking Details

Bank Name
Address
Post Code / ZIP
Country
Account Name
Account # / IBAN
ABA / Swift / Sort Code / Routing #		VAT No

	Projected Volume Details

	Type in your projected processing volumes (enter 6 Months)
Month 1 *	USD	Month 2 USD
Month 3	USD	Month 4 USD
Month 5	USD	Month 6 USD
Enter Average Ticket Size	USD

	Technical Contact Information

Technical Contact Name
Email
Telephone

Where did you hear about us?