Fiuu Merchant Service Application Form

Complete the form below with your details to apply for Fiuu’s Merchant Service

Fiuu Application Form

Section I: Registration Information

i. Company Registered Name

ii. MSIC Code

iv. Domain Name

SST No. (if applicable)

iii. TIN Number

v. Company Registration No.

vi. Company Registered Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

vii. Type of Business

viii. Preferred Merchant ID

ix. Company Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

x. Length of Time in Business

xi. No. of Employees

xii. Office Area Zoned

xiii. Office Space (square foot)

xiv. Authorized Contact Person

xv. Designation

xvi. Mobile Number

xvii. Telephone Number

xviii. Fax Number

xix. Primary Email Address

xx. Secondary Email Address

xxi. Display Email Address

Section II: Name of Company Director(s) / Shareholder(s)

i. Director Shareholder Name

NRIC No

Contact No.

ii. Director Shareholder Name

NRIC No

Contact No.

iii. Director Shareholder Name

NRIC No

Contact No.

Section III: Name of Authorized Person

i. Employee(s) Name

NRIC No

Contact No.

ii. Employee(s) Name

NRIC No

Contact No.

iii. Employee(s) Name

NRIC No

Contact No.

Section IV: Business Information

i. Type of Products / Services Being Marketed

ii. Targeted Market Region

iii. Industry (Please select from Table 1)

iv. Current Monthly sales

v. Estimated Average Billing Amount

vi. Estimated Monthly Sales Turnover

vii. Shipping / Fulfillment period

viii. Primary Business Face to Face

ix. Shopping cart / E-commerce System Used

Current Payment Gateway (if any)

xi. Why Leaving Current Gateway (if applicable)

xii. Latest 6 months Charge Back Ratio (if applicable)

xiii. Currently Accept Credit Card?

xiv. Business hours:

xv. How do you know about Fiuu?

xvi. Yearly Sales Volume Turnover:

xvii. No. of Employees:

Section V: Bank Account Information

i. Bank Name

ii. Bank Account No.

iii. Branch Location

iv. Bank Account Name

v. SWIFT Code

Section VI: Consent & Acknowledgement

I hereby declare that all information furnished herein is true and complete to my knowledge and give my/our consent for my/our information to be used by Razer Merchant Services Sdn Bhd purposes of the Merchant Service Agreement. I further agree to be bound by the terms of the Merchant Service Agreement including any amendments made or to be made thereto. I acknowledge and confirm that I have carefully read the provisions of the Merchant Service Agreement which are attached to this Merchant Services Application Form and have understood them and have not relied upon any statement, representation or waiver made by Razer Merchant Services Sdn Bhd. Other than that set out in the Merchant Service Agreement, I hereby irrevocably and unconditionally agree to observe, fulfil and comply with the terms of the Merchant Service Agreement.