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TERM

Duration of Term: 1 month


Automatic Renewals: This Merchant Agreement shall automatically renew for one-month terms until terminated pursuant to the Terms of Service or until Merchant provides Nuvei with a notice of non-renewal no less than fifteen (15) days prior to end of then-current monthly term.

MERCHANT BUSINESS INFORMATION
  • Legal Name (Ownership Entity):
  • Physical Address:
  • City:
Province
  • Postal Code:
  • Telephone # (Landline):
  • GST Tax ID:
  • URL:
How Long in Present Business?
  • Years:
  • Months:
  • Authorized Contact:
  • Email (Customer Service):
  • Email (Statement):
  • Merchant Customer Service # (if MOTO/Ecomm):
Previous Processor?
  • Name of Previous Processor:
Have you ever been subject of a Visa/Mastercard Risk Program?
  • If yes, which one
  • , when?
BUSINESS PROFILE
SALES PROFILE
Type of Ownership:
Merchant Type:
OWNERS, OFFICERS, AND MANAGEMENT (NO P.O. BOX #)
All beneficial owners (i.e. those with equity ownership equal to or greater than 25% and an individual who has significant managerial control in the entity) are required.

(If not selected, an addendum will be provided to fill out up to 3 more boxes.)
  • Title:
  • Email Address:
  • Percent Ownership: %
  • First Name:
  • Last Name:
  • Date of Birth (mm/dd/yyyy)
  • Home Address:
  • City:
Province
  • Phone #:
  • Postal Code:
ELECTRONIC DEBIT / CREDIT AUTHORIZATION
Please provide a pre-printed void business check or bank letter confirming your business account Transit # (ABA Routing) and Account # (DDA).
By providing this information, you are authorizing the Acquirer to initiate EFT debit and credit transactions to said account in accordance with section 5.10 of the Terms of Service.
VISA / MASTERCARD / INTERAC SALES PROFILE (be as accurate as possible)
Card Present (card swipe/chip)
Online Orders (Ecomm)
Monthly Volume:
Visa
$
Mastercard
$
Interac
$
Phone Orders (MOTO/Keyed)
Average Ticket:
$
$
$
High Ticket:
$
$
$
  • Total:
Seasonal? If yes:   
EQUIPMENT SCHEDULE
Qty
Description
  • Prix
  • Total
I confirm that I have read and understood and agreed to all services subscribed and their associated rates and fees, as well as the Equipment Rental Agreement found at www.nuvei.com/rental.
CONFIGURATION SCHEDULE
Tip Function 
Allow Interac Cash Back
  • Amount: $  
Terminal Auto Settle
If yes, what time?
Interac Surcharge (QC not accepted)
  • Amount: $  
Password Protect Refunds
Semi-integrated
INFORMATION SUMMARY

DATE OF CONTRACTS - Effective Date:

  • ...

Term: one (1) month, renewing automatically for additional one-month terms.

SCHEDULE A - FEE DISCLOSURE BOX
I confirm that I have read and understood all services subscribed and their associated rates and fees, as well as the Terms of Service referenced in this Merchant Application.
  • Merchant Initials:
BANK DISCLOSURE AND ACKNOWLEDGEMENT
I agree to the terms outlined above.
Principal Signature X:
  • Print Name: 
  • Date
ATTACH VOID CHECK HERE