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Merchant Account Registration Form

I want to use CCePay	Intangible Products Tangible Products
Gateway for:	Both Tangible, Intangible Products & Services

Company Information
Which of the following best describes your business?
Company Description
Description of Product's / Service's) Sold
Company Name:
Address:
City:
State / Province:
Zip Code / Postal Code:
Country:
Phone
Email1
Email2
Fax
Company Type	Private Ltd. Limited Govt. / PSU
	Proprietor Partnership Incorporated

Firm / Company Registration Details
Sales Tax #
Income Tax PAN #
Service Tax #
Company Registration ROC #

Account Executive
Primary Contact Name
Primary Contact Title
Primary Contact Email
Primary Contact Telephone

Web Site Information
Web Site Name
Web Site URL
Administration Email
Customer Service Phone #

Processing Information
Processing Currency
Average Transaction
Monthly Volume

Personal Information
Name of Director/CEO/Prop./Partner
Address
City
State / Province
Zip Code / Postal Code
Country
Phone #
Mobile #
Email
PAN / IT #

Choose Transaction Currency
	Indian Gateway (INR) More Details
	International Gateway (USD) More Details

Note: Settlement can be done in any Currency Worldwide via International Wire Transfer.