Integration Partner - Client Introduction Form Integration Partner: Integration Partner Contact Details Contact name: Work telephone: General e-mail: Technical e-mail: Client Name: Number of Tills & ATM (cardholder present only): MID Requirements of your client Please enter your Merchant ID Number(s) , given to you by your acquiring bank, for e-Commerce and/or Mail / Telephone Order (if applicable). Enter the 3 digit currency code in the boxes below that you wish to trade and settle in. Please confirm whether your MID is being used for Gaming authorisations (SIC: 7995) YES NO Can you confirm which country your MID is registered to? Merchant ID Number MID Type Trade In Settle In Acquiring Bank Please tick the Value Added Services your client requires Fraud Prevention Real Time Fraud Screening 3-D Secure Age and Identity Verification Bin Range Restriction Ceiling Limits Recurring Transactions Credit / Debit Card Continuous Authority Direct Debit Continuous Authority Tokenization Solutions Payment Tokenization (Pre-Registered Card) Card Tokenization Card Types Maestro MasterCard Debit MasterCard Visa Electron Visa Delta Visa Solo Additional Card Types American Express Diners(e-commerce only) Corporate Purchasing Cards Laser Cardholder Present Services Batch, Reversals, and Velocity are all required for CP processing. Batch Processing Reversals Velocity Limit Zero Other Services Chargeback Management Dynamic Currency Conversion e-Vouchers Online cash transactions Split Shipment PayPass Online Direct Debit & Direct Credits YES, I require the Direct Debit Service YES, I require the Direct Credit Service Originator ID No: (OIN) Sponsoring Bank: OIN type: AUDDIS AUDDIS PAPERLESS Please supply one e-mail address in which the electronic notification(s) should be sent: To ensure that you receive electronic notification of failed DD setups, please make sure you have completed section 6 of the BACSTEL IP form from your sponsoring bank. DataCash Reporting System Please supply details of the person who will administer DataCash Reporting Accounts for your organisation. IP Address to access Reporting: Existing Group Name: (optional) Username: Forename: Surname: E-mail Address: Telephone Number: Website: Description of products/services being sold / provided Additional Information Your comments: Confirmation I hereby declare the above information to be true and complete Please enter your name here: DataCash Ltd. 71 Kingsway, London, WC2B 6ST, United Kingdom T. +44 (0)870 7274 761 F. +44 (0)870 7274 781 E. [email protected] W. www.datacash.com