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First Name

Last Name

Email Address

Date Of Birth

Job Title

Select Country

ID Number

ID Type

City Or Town

Postal Code

Is there another owner, partner, officer, or director applying?

Yes No

Business name*

Legal business name*

Website URL*

Business phone number*

Alternate phone number*

Country

Street Address

City or Town

Region

Postal Code

Business description*

Business Type*

In general, how many days does it take to provide your product/service?

When are your customers charged?

Business registration number

Business started date`

Where is your company based?

Which countries in USA are you looking to sell?

Website or Apps Platform

What is your company's monthly revenue in USA?

How would you like to be contacted by Ticktappay?

Do you offer subscriptions?

Industry of your company

Refund Policy

Projected annual credit/debit card volume

Typical transaction amount

Largest expected transaction

Are you currently processing credit cards?

Bank account holder name

Name of Bank

Country

Street Address

Region

City or Town

Postal Code

Account Number

ACH/ BIC/ IBAN Code

Have you processed transactions with Lubynet before?

Company registration certificate

Director IDs copy

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strives to make transactions
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