Payee Info

Business Application

Welcome!

Below is a guideline of common documents you will need to provide to complete AptPay’s Merchant Application Form. Depending on your specific profile, document requirements may vary. If you’re unsure of what a document is or why it’s needed, please reach out to AptPay and we will be happy to assist.

To navigate the form, please use either the form progress on the left of your screen or the form back or next buttons and not your browser back or forward buttons.

Business Information

Add the business's basic information

Legal Business Name*

Doing Business As (DBA) Name i

Email*

Website Address/URL

Phone Number*

Add the business's address info

Country*

Address*

Apartment, suite, etc.

State / Province*

City*

Zip/Postal Code*

Add the business's contact info

Contact First Name*

Contact Last Name*

Contact Phone

Contact Email Address*

Where is the business registered?

Country*

State/Province*

Enter the business's profile information

Business Registration Number*

Nature of Business*

Sub Nature of Business*

Business Structure*

Upload your business registration or articles of incorporation

Choose file

When was the business registered?

Year*

Month*

Day*

Ownership Information

Beneficial Ownership

Is this a publicly traded company?

Yes

No

Ticker/Stock Symbol:*

Does any one individual own or control 25% or more of the business/entity

Yes

No

AptPay Services

Select which AptPay services you would like to use - Select all that apply

Apt-Send

Apt-EFT

Apt-X

Apt-X Transactions

Enter the merchant's cross border transaction information

Purpose of Payments*

Annual Volume ($) of Transactions*

Average Transaction ($) Size*

Expected Currencies - Select all that apply*

Expected Countries Sending To - Select all that apply*

Cross Border Authorized Personnel

Add Personnel

List the person(s) who are authorized to trade and make international payments on behalf of the company and submit or modify beneficiary instructions.

First Name	Last Name
No Data Available

The Applicant authorizes AptPay to open an account for foreign currency exchange and global payment services and to accept and rely on all orders and insturctions (whether oral, written or electronic) from anyone whom AptPay reasonably believes is an Authorized Representative of the Applicant. The Applicant authorizes the individual(s) listed above to provide AptPay with any information necessary to assist in its dealings with AptPay.

The Applicant certifies that: (1) it will be acting as principal, for and on its own behalf, and not on behalf of third party; (2) the information set out in this Form is correct, accurate and complete and will promptly notify AptPay of any change; and (3) the individuals signing this Form below have the requisite authority to bind the Applicant. the Applicant certifies that it has read, understood and agrees to the Terms and Conditions and Privacy Policy of AptPay.

I consent to the above language*

Personnel Information

List the person(s) who are authorized to trade and make international payments on behalf of the company and submit or modify beneficiary instructions.

Enter the person's name

First Name*

Last Name*

Enter the person's date of birth

Year*

Month*

Day*

Enter the person's address

Country *

Address Line 1 *

Address Line 2

State/Province *

City *

Postal Code *

Enter the person's job title

Job Title*

API Compliance Form

The Payment Card Industry Data Security Standard (PCI DSS) is an IT security standard for organizations that are involved in handling credit cards and their associated data. While administered by the Payment Card Industry Security Standards Council, the PCI Standard is mandated by the card brands, with the aim to tighten controls around cardholder data and reduce credit card fraud.

Will your business be handling or “touching” card data?

Yes

No

Are you PCI compliant?

Yes

No

Please indicate your organizations PCI compliance level

Our organization processes over 6 million card transactions annually.

Our organization processes 1 to 6 million transactions annually.

Our organization processes 20,000 to 1 million transactions annually.

Our organization processes fewer than 20,000 transactions annually.

Please provide your business’ PCI Report on Compliance (ROC).*

Choose file

Please provide your business’ PCI Attestation of Compliance (AOC)*

Choose file

Transaction Information

Add the business's transaction information

Currency*

Average Number of Transactions per Day*

Average ($) Volume per day*

Maximum Transaction Size ($)*

Transaction Type - Select All That Apply*

The Statement Descriptor is 4 to 10 alpha numeric characters in length, must have at least one letter and cannot be special characters and should reflect the DBA name. The Statement Descriptor will appear on the payees card/bank statements.

Statement Descriptor*

Please provide your Customer Service Phone Number to add to your Statement Descriptor that will appear on your customer’s bank statements.

Customer Service Phone Number

Please describe the type of Transactions you are planning on doing. For multiple use cases please define those here:

Transaction Description*

Where do you conduct client activities?

In Person

Online

Omni-channel

Auto Billing

Would you like to set up Auto Billing on your account?

The Applicant hereby authorizes AptPay to debit the below bank account for billing purposes

Bank Code*

Name on Account*

Routing/Transit Number*

Account Number*

Provide a void cheque/check or bank letter/statement*

Choose file

Gambling and Gaming Compliance

Gambling and Gaming (G&G) industry operators must fulfil specific obligations as required by various anti-money laundering regulations, to help combat money laundering and terrorist activity financing. G&G operators wishing to utilize AptPay’s services must provide the following documentation and/or information in order to utilize AptPay’s products and services.

I/we can provide a copy of our current/active regulatory licensing where our gaming operations are conducted:

Yes

No

Upload your Documentation*

Choose file

Please explain why*

I/we can provide a copy of our third party certification of age verification:

Yes

No

Upload your Documentation*

Choose file

Please explain why*

I/we can provide a copy of third party certification of our geofencing systems verification:

Yes

No

Upload your Documentation*

Choose file

Please explain why*

I/we can provide a copy of our Anti-Money Laundering Compliance program:

Yes

No

Upload your Documentation*

Choose file

Please explain why*

I/we can provide a copy of my/our OFAC or sanctions program in place that includes the escalation process if an OFAC or sanction hit occurs:

Yes

No

Upload your Documentation*

Choose file

Please explain why*

I/we can provide a copy of my/our most recent independent review of AML regulatory requirements or confirmation the review is available for inspection at [Name] request. The copy should include findings have been mitigated:

Yes

No

Upload your Documentation*

Choose file

Please explain why*

I/we can provide a copy of our most recent audited financials or equivalent:

Yes

No

Upload your Documentation*

Choose file

Please explain why*

Important Merchant Responsibilities

Ensure compliance with:

Cardholder data security and storage Requirements
Review and understand AptPay terms, conditions and agreements
Comply with card association operating regulations and payment regulatory bodies

Consent to Collection, Use and/or Disclosure of information

I confirm I am not acting on behalf of a third party*

I agree to be kept up to date with the latest information about products and services from AptPay. I can unsubscribe at any time. Please see AptPay's Privacy Policy

The Applicant agrees that AptPay may collect, use and disclose information (including personal information) as described in our Privacy Policy including to identify the Applicant or any of the individual persons listed in this Application, to provide ongoing Services (as defined in the Master Services Agreement), to protect both AptPay and Applicant from fraud or error, to comply with legal or regulatory requirements and to market other services to you.

Do you consent to the collection, use and disclosure of information (including personal information) by AptPay?*

The Applicant certifies that: (1) it will be acting as principal, on its own behalf and not on behalf of any third party and (2) the information set out in this Application is correct, accurate and complete and that the Applicant will notify AptPay of any changes to information in this Application within 7 days of such changes.

By signing, the Applicant certifies it has read, understood and agrees to the AptPay Master Services Agreement (including the Statement of Work) and the Privacy Policy. Each person whose information is on this Application consents to allow AptPay to obtain credit, financial and related personal or business information (including a credit information-report) about them from any credit bureau or credit reporting agency in connection with the Application. The Applicant warrants that the individual signatories are authorized to sign the Application on behalf of the Applicant

I agree and consent*

KYC Verification Process

If your business falls into one of the following categories, you must carry out a know your customer identification process:

Gaming and Gambling
Money Services Business
Non-Bank Lender
Online Auction
Multi-Level Marketing
Hemp/Hemp Derived CBD
Fund on Settlement
Travel Agency, Airline or Cruise Line

If your business falls into one of the above categories, do you carry out your own know your customer identification process on your customers?

Yes

No

KYC Verification Compliance

FinTRAC and FinCEN AML compliance regulations require the collection and recording of certain information about individuals and businesses utilizing Pre-Paid Cards, Push to Card (Credit/Debit), General Purpose Reloadable Cards and EFT, and in some circumstances, verify specific pieces of the information provided. When conducting Customer Due Diligence (CDD) during the onboarding process, the following information must be confirmed about the individual or entity utilizing the disbursement service:

That they exist;
That they are age of majority;
That they are located in an area permitted for the requisite service;
That they are who they say they are.

Do you have KYC Policies and Procedures you can provide to us?*

Yes

No

Please explain why*

Upload your KYC Policies and Procedures*

Choose file

Please provide name of the KYC verification vendor tool utlizied or describe your KYC verification process*

Please list the KYC identifcation information collected from your customers (name, address, date of birth, etc.)*

How long does your organization maintain identification and verification information?*

I/we confirm that the identification and verification information can be provided to AptPay within 15 days of the request to meet regulatory requirements.*

Yes

No

Please explain why*

Personnel

Add Personnel

Authorized Personnel

List the person(s) who are authorized to submit or modify information and instructions to AptPay.

First Name	Last Name
No Data Available

Directors

A member of the board elected or appointed to oversee the affairs of the business

First Name	Last Name
No Data Available

Owners

List all individuals and businesses who, directly or indirectly, own or control 25% or more of the business/entity

First Name	Last Name
No Data Available

Signatories

First Name	Last Name
No Data Available

Personnel Information

Select which personnel type this person is - Select all that apply

Authorized Personnel

Owner

Director

Signatory

Enter the person's name

First Name*

Last Name*

Enter the person's ownership percentage

Ownership Percentage*

Enter the person's date of birth

Year*

Month*

Day*

Enter the person's address

Country *

Address Line 1 *

Address Line 2

State/Province *

City *

Postal Code *

Enter the person's occupation

Occupation*

Enter the person's job title

Job Title*

Enter the person's social security number

SSN*

Please sign below

Signature*

Add the signatory's Government Issued Drivers License or Passport

Front of Document*

Choose file

Back of Document (required for drivers license)

Choose file

Signatory Information

Enter the person's name

First Name*

Last Name*

Enter the person's date of birth

Year*

Month*

Day*

Enter the person's address

Country *

Address Line 1 *

Address Line 2

State/Province *

City *

Postal Code *

Enter the person's job title

Job Title*

Enter the person's social security number

SSN*

Please sign below

Signature

Add the signatory's Government Issued Drivers License or Passport

Front of Document*

Choose file

Back of Document (required for drivers license)

Choose file

Summary

Please review all of the following information and make any necessary corrections before submitting the form.

Basic Business Info

Legal Business Name

Doing Business As (DBA) Name

Email

Address

Apartment, suite, etc.

City

Zip/Postal Code

State / Province

Country

Website Address/URL

Phone Number

Contact First Name

Contact Last Name

Contact Phone

Contact Email Address

Business Profile

Country

State/Province

Taxpayer Identification Number (TIN)

Business Registration Number

Nature of Business

Sub Nature of Business

Business Structure

Business Registration Document

Registration Date

AptPay Services

Services

API Compliance

Business handling or “touching” card data?

PCI Complaint?

Compliance Level

PCI Compliance Document

Apt-X Transactions

Purpose of Payments

Annual Volume ($) of Transactions

Average Transaction ($) Size

Expected Currencies

Expected Countries Sending To

Apt-X Authorized Personnel

Auto Billing

Bank Code

Account Name

Routing/Transit Number

Account Number

Void Cheque

Transaction Information

Currency

Average Number of Transactions per Day

Average ($) Volume per day

Maximum Transaction Size ($)

Transaction Type

Statement Descriptor

Customer Service Phone Number

Transaction Description

Where do you conduct client activities?

Ownership Information

Publicly Traded

Stock Symbol

25%+ Ownership

Consent

Authorized Personnel

Directors

Owners

Signatories