High-Risk Business – Greenlads

High Risk Form

Corporate Company Information

Merchant URL (Website)

Company Legal Name

DBA Name

Line of Business

Merchant Address Line 1

Merchant Address Line 2

City

State

Postal/ Zip Code

Incorporated Country

Registration/ Incorporation Date

E-Mail

Telephone

Fax

Tax ID Number

Contact

Name

Telephone

Fax

E-Mail

Forecasted Information

Maximum Number of Transactions

Maximum Transactions Volume (USD)

Maximum Number of Transactions per card

Average Ticket Amount

Maximum Ticket Amount

Processing History (Respond Accordingly)

Ever processed credit cards before

Yes

6 months processing history provided

Yes

Last 2 years Financial Statements (audited preferred) for parent company and merchant provided

Yes

Years of Experience in eCommerce/ Age of eCommerce Business

Processing Bank’s Name

Reason for leaving processor (if applicable)

Current Total Annual Income: US $

Current Chargeback to Sales Ratio

If requested, can you provide documentation to verify your Business existence, Business structure, Ownership Verification, and required Business Licenses (if any)?

Choose File

Have you provided company’s business plan?

Yes

Does the website owner control the site content?

Yes

Do you provide services to websites that are not fully owned by you?

Yes

Merchant Pre-Screening / Information Form

Business Documents for Underwriting Review (If requested)

1. Government Issued ID (i.e. Driver’s License, Identification Card)
2. Due Diligence Documents of the Directors, Shareholders and Beneficial Owners, which may
include:
2.1 Resume/Curriculum Vitae (C.V.)
2.2 Government Issued ID (i.e Drivers License, Passport, Consular Card)
2.3 Bank Account Verification
2.4 Proof of Address
3. 3 Months processing statements showing chargebacks (details of previous relationship
with an acquirer: Name of Acquirer, Sales Volume, Chargebacks and Fraud history).
4. 3 Months of Bank Statements from your current bank
5. Financial Statements (Profit and Loss Accounts, Balance Sheets and Cash Flow
Statements) for the past 2 years (audited preferred).
6. Copy of Certificate of Incorporation for existing parent company.
7. Incorporation Documents showing Directors & Shareholders and Beneficial Owners
8. Detailed Business Plan including Operations Review, Organizational Structure, Financial Highlights, Credit Card Security Procedures, bio/resumes of key members of the management team

All requested documents may not apply depending on your business type, time in business, and
history; however, please provide as much documentation as possible to supplement the
application. If there are any questions, please do not hesitate to email sales@greenladspay.com.

Note: If you want to explain more about your business, please use the field below:

High Risk Businesses form

Corporate Company Information

Contact

Forecasted Information

Processing History (Respond Accordingly)

Merchant Pre-Screening / Information Form

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