MERCHANT INFORMATION Salesman I.D. or Name: Legal Name: DBA Name: Street Address: City: State: Zip: Country: Contact: Phone: Email: Fax: Date Business Started: Years at this location: Num. of Locations: Fed. Tax ID: Type of Ownership: Sole Proprietorship Partnership Corporation LLC Other Country of International Business Corporation: (Percentage of Business) Mail Order: % Telephone Order: % Website URL: Merchandise/Service/Product Sold (provide details): _ PROCESSING INFORMATION Monthly Volume $ Avg. Ticket $ Estimated Chargeback trx. Vs. trx. Percentage: % Estimate Actual Seasonal: Yes No High Volume Months Current/Previous Credit Card Processor: Phone: If you have an existing/previous processor, what is your reason for seeking alternative processing? What Payment application do you use for online sales? If you have an existing/previous processor, what is/was your MCC (merchant category code)? Is a third party fulfiller being used? Yes No If Yes, please provide details: CREDIT REFERENCE INFORMATION Principal Bank: Account No.: Length of time in the bank: Contact: Prior Bankruptcy: Yes No I am entering into a business relationship with Credicorp Bank that is conditional on a satisfactory background check. I understand that this information is being collected for the purposes of conducting background due diligence screening and I declare that the information provided for this purpose is complete, true and correct, to the best of my knowledge. I understand that any incomplete, incorrect or false information furnished by me may disqualify me from this business opportunity. As part of the background due diligence procedure and as a condition of acceptance of the business proposal, I have agreed to allow a background investigation and verification of information which will be performed by whomever Credicorp assigns. I hereby authorize the investigator to obtain any information concerning my employment history, my education record, my consumer credit record, my driving record, my criminal record, my prohibited person information, my conditional and absolute discharges that have not been removed from the national criminal records system in accordance with the Criminal Records Act, and/or any other information in your possession relevant to my potential business relationship with Credicorp Bank. WAIVER OF RIGHTS By submitting this Application, Applicant acknowledges and agrees that Credicorp Bank, Inc. and/or any of its affiliates or subsidiaries or any third party under contract with Credicorp Bank, Inc. and/or any of its affiliates and subsidiaries, will conduct a thorough due diligence investigation (the investigation ) at Applicant s cost. Applicant hereby consents to the conduct of the investigation and waives the applicability of any legal privilege or protection it may have regarding its commercial, personal, financial and any other, data, records and/or information of any nature regarding Applicant, its principals, managers, shareholders, subsidiaries and/or related parties (the information ) which may be gathered through the investigation. Applicant further waives any claim against Credicorp Bank, Inc., its affiliates or subsidiaries and any third parties hired by the above to conduct the investigation, regardless of the method used for the investigation. Accordingly, Applicant agrees not to pursue any claims relating to the investigation, whether or not the information obtain was released to any third parties and whether or not the information was obtain lawfully or not, regardless of the means used to obtain such information Signature Date Signature Date Printed Name Date Printed Name Date
BUSINESS MODEL INFORMATION [Please ensure a cover letter is included in the application] How long from the date of purchase does it take for the customer to receive their order? What is the method of shipment (if applicable) Will goods be shipped cross-border? Yes No Is there a tracking info. Available? Yes No If Yes, Provide courier s name Is a Delivery Receipt Requested? Yes No Will the customer be billed monthly? Yes No Is there a free trial? Yes No What good and/or service is being sold? If applicable, please state export or legal restrictions: Briefly describe how you make a profit: What is your refund policy? What is the percentage of refunds (to your total monthly sales)? %. How many days does it take to issue a refund? Days When do you charge the Customer? By the time of Order After shipment or Completion of Services Do you own the product/inventory at the time of sales? Yes No Who enters the credit card information into the processing system? Customer Merchant Fulfillment Center Other Is there anything else regarding your business model which you wish to explain/clarify? Target market? (Must equal 100%): Marketing Method (Must equal 100%): Canada % USA % UK % W. Europe % Australia % New Zealand % E. Europe % Latin America % East Asia % Africa % Bulk Postal Mail % Internet % Emails % Outbound Telephone % Search Engine Registry % Pop-ups % Referrals % Up-sell % TV/Radio % MLM % Printed Name Date Printed Name Date
Name: Title: Address: OWNERS OR OFFICERS Name: Title: Address: City/State/Zip/Country: City/State/Zip/Country: Home Phone: Home Phone: Social Security Number: Social Security Number: Date of Birth: Date of Birth: Please list any business that the business or its owner owns or operates, has owned in the past or is involved as a director: CORPORATE CERTIFICATION I certify that I am the elected and qualified (title) of the corporation whose full legal name appears on the Merchant Application. I certify that the corporation has duly adopted, in accordance with the corporation s articles and bylaws, a resolution that is still in force and effect that authorizes me and any of the following person(s) to act on behalf of the corporation to contract with Bank and ISO and to act on behalf of the corporation in all matters relating to the Merchant Agreement. I further certify that Bank and ISO may rely on this authorization until either or both receive actual notice of any change and further certify that the following are the names(s), genuine signature(s) and title(s) of the person(s), other than me, so authorized. Name: Signature: Title: In Witness Whereof, I have subscribed my name as Name: Signature: Date: (title) of the corporation. Operating System: Web Technology: TECHNICAL INFORMATION Web Server Software: Are you hosting your own web site? Yes No If no, who is: Do you have a system administrator available? Yes No Comments: _ Do you have a preferred Gateway? Yes No If Yes, who is: In which currencies do you need to process? USD EUR GBP CAD Other If login is required to your website, please provide a test account UserId and Password: UserId Pasword Other Technical requirements/comments: _ SIGNATURES By signing below, Merchant (i) represents that the information provided by Merchant in this Bank Merchant Agreement is true, complete and not misleading; (ii) acknowledges that Merchant has read and understands this Agreement and Operating Procedures and agrees to be bound by their terms; and (iii) authorizes Company and its agents to credit and debit the Account in accordance with this Agreement and represents and warrants to Bank and ISO that the party signing this Agreement is authorized to do so and to act on behalf of the Merchant in the performance thereof. MERCHANT: BY: TITLE DATE SIGNED: BANK: BY: TITLE: DATE SIGNED: BY: TITLE: DATE SIGNED:
REQUIREMENTS TO OPEN A MERCHANT ACCOUNT 1. Application form should be completed with all the required information, including last 6 months of processing history. 2. Merchants should process a minimum of USD $10,000.00 / month. 3. Website must show privacy, security and refunds policy as well as the pricing of product(s) without deceptive advertising. 4. Website must show contact information (e-mail, phone number, fax) 5. Shipping preferably by courier, if not, merchant should state that all customers receive a bill or receipt. Step-by-Step Guide STEP 1: Fill-out a Credicorp Bank (CCB) Merchant Application form & attach six months of processing history and an ID. STEP 2: CCB completes the pre-approval process and requests additional information. STEP 3: Upon receiving the required documents and the completion of due diligence, a processing contract is offered to the merchant. STEP 4: On acceptance of the contract, Merchant ID & Terminal ID codes are given to merchant; a Merchant Bank account is opened*. Step 5: Testing begins with your gateway(s) and processor(s) taking 3-5 days. STEP 6: Processing begins. Note: To ensure timely processing of all documents, please make sure that all required information fields and documents are complete; signatures on all documents match those on passports; the correct signatories are signing.
Written information required after Pre-Approval Process: 1. Chapter of incorporation of company and Certificate of Good Standing. 2. Copies of Owner(s) s and principal(s) s passports or I.D. cards. 3. Copies of Owner(s) s and principal(s) s driver s license. 4. Copy of operational license. 5. Gas, Water or electricity bill with company address. 6. Shipment information (shipping company, delivering time) 7. Business model or plan (markets, product description, product history) 8. Refund policy. 9. Financial Statements (most recent balance sheet / income statements). 10. Tax return of the last 2 years. 11. Bank References on letterhead addressed to CCB (2). 12. Commercial References on letterhead addressed to CCB (2) (can be issued by providers). 13. Payment Card Industry Form. 14. Signed Tri-Party/Bank Disclosure form *Requirements to open a Deposit Account (Savings, Current Accounts and Time Deposits) at CCB: *Panamenian Company Incorporation is required* Complete and sign the following documents: 1. Account Opening Declaration 2. Profile of Directors, Officers, Signatories, Shareholders and New Headlines. 3. General Resolution. 4. Minutes of Board of Directors. 5. Board Act to authorize membership in the Online Banking service (If applicable). 6. Affidavit. 7. Two (2) Signature Cards. 8. Uniform Acceptance 9. Information Note for Citizens and residents of the United States of America (If applicable). 10. Online Banking Application - Legal Entity (if applicable). 11. Debit Card Request (if applicable). 12. Checkbooks application (only for current accounts) (if applicable).
13. Valid IDs of directors, officers, signatories and shareholders of the company. (If Panamenian) 14. Valid passports of directors, officers, signatories and shareholders of the company. (If foreign) 15. Second identification documents current directors, officers, signatories and shareholders of the company: ID or Driver's License or Social Security Card or Student Card 16. APC Authorization (of the company and of each of the directors, officers and signatories of the company). 17. Credit References (of the company and of each of the directors, officers and signatories of the company) to reflect a credit history with a maximum of sixty (60) days past due (current accounts only). 18. One (1) Bank Reference Letter and one (1) Commercial Reference Letter, addressed to Credicorp Bank or "To Whom It May Concern" of company, dated no more than 3 months ago. 19. Certificate of Good standing from the Panamenian Public Registry. (original) 20. Copy of Articles of Incorporation and any amendments thereto. 21. Two (2) latest Income Tax Returns or Financial Statements. Note: If the Legal Entity has been recorded recently in the Public Registry, you must apply one (1) Bank Reference Letter and one (1) Commercial Reference Letter from the President of the Board or any member thereof and Notice of operation (if applicable), according to Article 4 of Law No. 5 of January 11, 2007. For further details, please feel free to contact us at: Credicorp Bank Tel: (507) 210-1111 Fax: (507) 210-0414 E-mail: ecommerce@credicorpbank.com Rep. Of Panama, Panama City Calle 50, Ave. Nicanor de Obarrio Aptdo. 833-0125
LIST OF RESTRICTED MERCHANT ACTIVITIES We know that certain merchants carry more risky activities or require the application of more specific market knowledge that they develop on their own. Therefore, the following types of merchants are excluded by Credicorp Bank unless it is approved by the Bank s management team. This is not an exclusive list; other businesses can be denied by the nature of their business and related risks after an analysis. 1. Age Verification 2. Airline Ticket Sales 3. Alcoholic Beverages 4. Animal Sales And Breeding 5. Antiques or Collector Items 6. Any Product or Service Considered Illegal 7. Charities Through Outbound Telemarketing 8. Check Cashing Services Collection Agencies 9. Child Pornography and Other Illegal Adult Entertainment 10. Credit Card Protection 11. Credit Repair Agencies 12. Dating Websites 13. Drug Paraphernalia 14. E-Cash Merchants 15. Exporters of Any Kind 16. Foreign Exchange 17. Future Delivery Beyond Three Months 18. Gambling 19. Gaming, Lottery and Raffles (Including Online Gaming Downloads) 20. Golf Clubs or Accessories 21. Home Based Gun Dealers 22. Investments By Internet 23. Life Time Guaranteed Products 24. Multilevel or Pyramid Marketing 25. Online Sale of Prescription Drugs 26. Outbound Telemarketing 27. Pawn Shops 28. Programs On How To Apply For Low Interest Credit Cards 29. Replicas 30. Third Parties Billing Processing Aggregators 31. Tickets (Travel, & Others) 32. Timeshare Programs 33. Tobacco 34. Travel Clubs and Reservation Centers 35. Products Originally From Cuba, Libya, Syria, Iraq, Iran, Nigeria, Afghanistan, North Korea, Eastern European and/or any OFAC Restricted Countries.