1 Company / Individual information 2 Website / E-commerce information 3 Settlement information Company / Individual Information Merchant Name Commercial Register Number Date of Commercial Registration Place of Commercial Registration —Please choose an option—BeirutMount LebanonNorthSouthBekaaNabatieh VAT Code M.O.F Number Full Address Email Landline Number Mobile Number Bank Name Authorized Signatory Name Email Mobile Number Operation Officer Name Email Mobile Number Accountant Officer Name Email Mobile Number Web Developer Name Email Mobile Number Next Website / E-Commerce Information Website Address, URL or mobile app Instagram Page Website Platform —Please choose an option—Appy PieBigCommerceContentfulDrupalDudaEcwidFlutterGoDaddyHostGatorHostingerHubSpot CMSIM CreatorIONOSIn-House DevelopmentJimdoJoomlaMagentoOdoo WebsiteOtherPrestaShopRegxaSITE123ShopifySitecoreSquareSquarespaceTilda PublishingWebEasy ProfessionalWebStartsWebflowWeeblyWixWooCommerceWordPressYolaZoho Site Commercial Name (to be shown on cardholder bank statement) Description of Products / Services Minimum amount expected per transaction Maximum amount expected per transaction Monthly Volume expected Back Next Settlement Information Bank details Beneficiary Name Bank Name Branch —Please choose an option—BeirutAchrafiehHamraJouniehTripoliSaidaZahleOther IBAN USD IBAN LBP Frequency DailyWeeklyBi Monthly Requested Services Hosted Check-outTokenizationLink2pay Accepted Cards VisaMastercardAmex How did you know about NetCommerce? —Please choose an option—ReferralSocial MediaGoogleSales TeamOther I Hereby Certify all the information in this application are correct. I also authorize NetCommerce and /or any of its affiliates to verify any information included in this application. Back
