PayItOnline Merchant Application
	All required fields are marked with an *   Contact Information *Business Name: *Address1:  Address2:  Address3: *City: *Country: *Contact Name:  Email Address: *Phone:  Fax: Merchant Information *Nature of business: Retail Office Home Based Trade Shows Mail/Telephone Order Warehouse Seasonal Charity Target market: Consumer retail Commercial industrial Years in business under current ownership: Processing Currency: Australian Dollar Canadian Dollar German Mark Euro French Franc Hong Kong Dollar Japanese Yen New Zealand Dollar British Pound Singapore Dollar South African Rand Swiss Franc United States Dollar Projected monthly volume  of Credit Card transactions: What PayItOnline service are you registering for? Business applies for merchant number through BANQONIT Business has its own BNZ merchant number Comments: Application Completed by:
	For further information contact sales@BANQONIT.com Copyright 2000 BANQONIT All rights reserved. Revised: November 10, 2000