DATE:
PARTNER ID:
Application for TellerAgreement
Card present transactions
Application for the acceptance of face-to-face transactions and unattended terminal (UAT) transactions.
1 Card types applicable to this agreement
Please tick the card types for which you wish to apply. If you do not tick any cards, we will set up all card types.
MasterCard / Maestro
Visa / Visa Electron / V PAY
JCB
UnionPay
For merchants situated in Denmark, Norway, Sweden and Finland
American Express
Only for merchants situated in Denmark (in DKK) and Norway (in NOK)
2 Merchant details
2.1 Company reg. no. 2.2 Company name
2.3 Company address
2.5 Town/city
2.7 Group/chain, if any
2.6 Country
2.4 Postcode
2.8 Business sector/line of business
2.9 Company contact person (for this agreement)
2.10 E-mail (contact person)
2.11 Name of person authorised to sign
2.12 Telephone (contact person)
2.13 Merchant name (Point of sale/doing business as) 2.14 Contact person (at point of sale) 2.15 Phone number at point of sale
2.16 Merchant address (point of sale)*
2.17 Postcode*
2.18 Town/city*
2.19 Country*
* If other than company address
3 Settlement information
Account number for deposit of settlement
3.1 Reg. no.
3.2 Account number
3.3 IBAN number
Cross border Card present ENG 06.2014 Teller A/S (reg. no. 27226086) Part of the Nets Group www.teller.com
Page 1 of 3
PARTNER-ID:
Application TellerAgreement Card present transactions
3.4 SWIFT/BIC code
3.5 Sort Code (SC) For German merchants when EUR
account and English merchants when GBP or EUR account
3.6 Transaction currency* 3.7 Settlement currency*
* Normally transaction currency and settlement currency are the currency of the merchant country
3.8 Settlement advice:
PDF
(write e-mail)
3.9 E-mail for PDF settlement notification
3.10 E-mail for CSV settlement notification
CSV
(write e-mail)
3.11 Settlement for MasterCard, Visa, JCB and UnionPay
Weekly collection of card revenue and
weekly notification
You receive card revenue and settlement
notification once a week. Your merchant’s card
revenue is collected from Tuesday one week
to Monday the next week. This Monday Teller
sends the settlement notification. The card
revenue will be accessible on your account after
two banking days.
Running settlement after 7 days and
notification sent daily
You receive card revenue and settlement notification every day running. Your card revenue
from Tuesday one week will be transferred to
your account Tuesday the next week – 7 days
later. Settlement notification will be sent to you
the same day as we transfer the revenue. The
money is accessible on your account after two
banking days.
Monthly settlement and monthly
notification
You receive card revenue and settlement notification once a month with 2-33 days old revenue.
Your card revenue is collected the first to the last
day of the month. The next banking day we send
your settlement notification with information
about the card revenue of the previous month.
The money is accessible on your account after
two banking days.
3.12 Settlement for American Express
Weekly settlement
Monthly settlement
Collection of card revenue is from Saturday to Friday. Card revenue will be
accessible on your bank account on Wednesday or Thursday the following
week. Settlement notification is sent on Sunday prior to settlement. Nonbanking days do not affect your settlement.
Collection of card revenue is once a month. Settlement notification is sent
on the 28th of a given month after the card revenue. Card revenue will be
transferred to your account one month after the collection is made. Nonbanking days do not affect your settlement.
4 Turnover
4.1 Describe type of goods/services sold
4.2 Price of the most expensive product/service 4.3 What is your prime business?
4.4 Average transaction amount
4.5 Estimated annual turnover
4.6 Estimated monthly debit/credit-card turnover. Only required for merchants with seasonal fluctuations in sales (e.g. holiday resorts).
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
No
If No, go to section 6
OCT
NOV
DEC
5 Pre-payment
5.1 Do you accept pre-payments? Yes
If Yes, please specify:
5.2 Describe the goods/services that are pre-paid (e.g. hotels/accommodation, travels, furniture, gift cards, membership)
5.3 What percentage of the total estimated turnover
will be pre-paid?
%
5.4 On average, how many days from payment
date to delivery date?
Days
Cross border Card present ENG 06.2014 Teller A/S (reg. no. 27226086) Part of the Nets Group www.teller.com
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PARTNER-ID:
Application TellerAgreement Card present transactions
6 Authorised signature
By signing this application you accept that the below, which is available on www.teller.com/terms, forms part of TellerAgreement:
■ Terms and Conditions
■ User Guide
■ Security in connection with card payments – face-to-face transactions
By signing this application you consent to:
■ Teller gathering information from your bank about the identity of your
business and its accounts
■ Teller passing on information about your company’s payment card
agreement to another bank, including information on the size and
number of payment transactions
■ Teller storing, processing and passing on information about the
payment card agreement, including CPR no. and reg. no. for the
purposes of credit rating, contact with your bank and administration
of the payment card agreement
■ Teller using the above information for statistical purposes
■ Teller sending changes to the terms and conditions to your business
by e-mail
■ Teller registering information about you and your business. We use
this information in risk assessment and agreements. We store the
information for as long as we need it.
Do you wish to receive e-mails with information on products, rules and trends in the market from Teller and other companies in the
Nets group in the areas of acquiring, payment cards, payment services and payment terminals etc.?
No
Yes
Company, location and date
Signature
Name in CAPITAL LETTERS
Documentation
When sending your application, you must attach the documentation below. We are unable to process your application
without the required documentation.
Account documentation: Documentation that the account given for belongs to your company. (e.g. copy of statements or other bank documentation. The name of the bank, the full legal name and/or company reg. no., reg. and
account number of the company must be shown)
Appendix 1: Copy of photo ID
Appendix 2: Ownership
The following also applies:
For partnerships:
Associations:
– The company’s latest registration certificate
– Latest personal account statements for all the owners
Limited companies and public limited companies:
– Copy of the company’s latest registration certificate
Sole traders:
– Articles of association (the persons who are authorised to sign
must be stated)
– Minutes of general meeting where the latest board was elected
(the persons who are authorised to sign and their titles must
be stated)
– Latest annual accounts
Funds:
– Copy of latest registration certificate
– Latest personal account statement
– Deed of foundation (the persons who are authorised to sign
must be stated)
E-mail
www.teller.com/contact
Mail
Teller A/S
Lautrupbjerg 10,
DK-2750 Ballerup
FAO CS Adm
Contact us
Fax
+45 44 89 26 80
If you have any questions,
please contact
+45 44 89 24 80
Cross border Card present ENG 06.2014 Teller A/S (reg. no. 27226086) Part of the Nets Group www.teller.com
Page 3 of 3
14262 • 06.14 • Bohemian.dk
Send the signed application and documentation in one of the following ways:
PARTNER-ID:
Identification, appendix 1, application TellerAgreement
Copy of valid ID from the person signing
The person must be authorised to sign.
Place your photo-ID in this box and take a copy.
Company reg. no. as stated on application
Return this photo ID (with the application)
Mail: Teller A/S, Lautrupbjerg 10, DK-2750 Ballerup, Denmark, FAO CS Adm.
E-mail: Scanned document: www.teller.com/contact
Fax: +45 44 89 26 80
TellerENG
AS 05.2014
Foretaksnummer
224no.
994
Teller is part
Teller A/S990
(reg.
27226086)
Partofofthe
theNets
NetsGroup
Group www.teller.no
www.teller.com
Appendix 1
PARTNER-ID:
Beneficial owners, appendix 2, application TellerAgreement
Listed companies are not required to complete appendix 2.
On commencement of the agreement, Teller is required pursuant to the Danish Money Laundering Act to obtain information on the
owners of the company if there are owners who own 25 % or more of the company.
Do one or more person(s) own 25 % or more of the company?
No
If no, you are not required to complete this document
Yes
If yes, complete name and address for these persons and send a copy of their passport
Owners living outside Denmark, Sweden or Norway must sent a copy of their passport.
Owner 1 (send a copy of passport)
Name:
Social security number: (Only for persons living in Denmark, Norway or Sweden)
Address:
Owner 2 (send a copy of passport)
Name:
Social security number: (Only for persons living in Denmark, Norway or Sweden)
Address:
Owner 3 (send a copy of passport)
Name:
Social security number: (Only for persons living in Denmark, Norway or Sweden)
Address:
Owner 4 (send a copy of passport)
Name:
Social security number: (Only for persons living in Denmark, Norway or Sweden)
Address:
Company reg. no. as stated on application
Return this documentation (with the application)
Mail: Teller A/S, Lautrupbjerg 10, DK-2750 Ballerup, Denmark, FAO CS Adm.
E-mail: Scanned document: www.teller.com/contact
Fax: +45 44 89 26 80
ENG 05.2014 Teller A/S (reg. no. 27226086) Part of the Nets Group www.teller.com
Appendix 2