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Please fill in this form and press the Submit button. The form will then be mailed to our sales department. We will then send you two paper copies of your contract by regular mail. If you have any questions, please mail to info@gsprocessing.com. All fields are required unless marked by a (*).
1. Merchant contractual information
Company Name :
The name of your online store (if applicable)* :
URL of the online store (or your own url)* :
Description of sales :
Contract start date :
Name of Person Signing the Contract :
Registration # Chamber of Commerce :
Chamber of Commerce in :
Date of Establishment of the Merchant :
Address :
Postal Code :
City :
Country :
Telephone Number :
Email :
Your Contact Person* :
Service Level (see contract) :
 Standard Corporate
Payment service type :
 INTERNET MOBILE
2. Merchant technical and administrative information
If you do not know this information, you can fill it in separately at a later time. Please always include your company name in the form above. Note however that we can only accept you as a customer if all fields of this form are filled!
Bank Account Number :
Sort Code (UK only) :
Bank Name :
Bank Account Holder Name :
Name E-Mail Phone Fax
Administration Contact :
Technical Contact :
Technical Contact Emergency Phone :
     
Referrer IP Address :
URL HTTP(S) Payment Confirmations :
URL HTTP(S) Payment Confirmations - Method (POST or GET) :
Email Address Payment Reports/Confirmations :
Remarks :
System type
(IIS/ASP, Perl, Site Server, Intershop...) :