Merchant Application Form

What is your merchant relationship with Orco Bank N.V.?

Previous Legal Name

Business Legal Name

Business Trading Name (doing Business as)

Trading name will appear on POS receipt if name also appears on KVK extract under 'handelsnaam'

Business Legal Address (mailing address)

Number of Physical Locations

Where the POS will be located. This location will appear on POS receipt

Name of physical location (short name)

Name of physycal location (short name)

Business Telephone/ Cellphone Number

Business Website

Name of Managing Director/ Owner

Name of Contact Person

Merchant Email Address

This email address will be linked to merchant statements & Login portals for transaction reconciliation purposes

Type of Merchant Business Retail Hotel/ Lodging E-commerce Restaurant Car Rental

Main Products/ Services Sold

Business Current Account Number in ANG

Business Current Account Number in USD

Settlement of sales (select one) Settle all sales (ANG & USD) in ANG bank account Separate sales of ANG & USD in assigned bank account

Average Sale Ticket Size (average receipt amount that a customer/ client might pay at your location for your product or services.

approx. in ANG

approx. in USD

Average monthly sales that were done by card at your location for your product or services.

approx. in ANG

approx. in USD