merchant application

Please have the following available:


1. Sole Trader, Partner or Director(s) personal information:

(Partnerships, information is required for both partners; and where there is more than one director, a minimum of two required)


2. ID Details (NZ Driver Licence or Passport Number)

Note: If ID is a foreign passport a certified copy must be received


3. A Business Bank Statement

For Verification please provide a copy of a business bank statement showing:

(Legal Entity name, Bank Account number and issue date no older than 3 months)


4. EFTPOS Terminal ID

Terminal ID will be 8-10 digits and can be obtained from any receipt printed by the terminal.

If unsure, please provide a copy of a receipt for verification

merchant application

Note: Your privacy is very important to us. To better serve you, the form information you enter is recorded in real time.

 

Referred to as the "Issuer"

Please tick boxes below for the finance facilities you require: (Referred to as the "Issuer")*

Farmers Finance Card

Is the easy way to pay at Farmers and thousands of other stores nationwide. Keep it in your wallet and you’ll be able to shop for your family, stock up on groceries, fuel your car, and get exclusive Cardholder offers to help you save while you spend.

Q Card (Eftpos)

 Is a credit card that gives Q Cardholders a minimum of 3 months no payments and no interest when they use their Card for in-store and online purchases. Today, Q Card has a prominent place in the wallets of thousands of New Zealanders, helping them buy the things that matter.

Q Eftpos Online

We can easily enable Q Card's standard 3 months payment holiday and interest free finance transactions on your website.

Long Term Interest Free

Lets your customers make a big-ticket purchases on our interest-free and/or payment holiday terms.


Referred to as the "Merchant"

What good/services are you providing?
Average monthly turnover each month
Are you affiliated with another organisation?*
Are you a Franchise or Corporate company?*
Your legal entity is*
Example 9429038167249 (13 digits)
Date Incorporated*
First day of trading *

Note: We will require a copy of the Trust Deed

How many partners or directors do you have ?*
Do you have a physical store?*
Who is your Eftpos provider?*
Change of Ownership*
First day of trading *

Business contact details

Business Physical Address*
Postal same as Physical?*
Business Postal Address*

Please “tick” if you DO NOT authorise publication of the business’s Trading Name, Physical Address and Website on our online store locator.
Administrator Contact Details *
Date of Birth*
Our ‘Welcome’ sales portal, used for processing sales and adding new users, requires a key administrator – please provide the name and date of birth who will be responsible for this.

Who is the internal key contact (Business and IT) we should deal with for integration?


Name*
Who provides your eCommerce payment gateway*
Note: This will be unique to any of your POS Merchant IDs/#s

Who is your primary contact for loss prevention (fraud) purposes?

Name*

Sole Trader, Partner or Director(s) personal information

NOTE: Partnerships, information is required for both partners; and where there is more than one director, a minimum of two required

 

Name*
Date of Birth*
Residential Address*
Expiry Date*
Upload a certified copy of your Foreign Passport *
No File Chosen
File uploads may not work on some mobile devices.
Maximum document limit is 1MB
I confirm the Foreign Passport copy uploaded is certified*

Second Partner or Director(s) personal information

Name*
Date of Birth *
Residential Address *
Expiry Date*
Upload a certified copy of your Foreign Passport*
No File Chosen
File uploads may not work on some mobile devices.
Maximum document limit is 1MB
I confirm the Foreign Passport copy uploaded is certified*

Business Bank Account Number

Terminal ID will be 8-10 digits and can be obtained from any receipt printed by the terminal. If unsure please provide a copy of a receipt for verification.
Please upload a Business Bank Statement for verification *
No File Chosen
File uploads may not work on some mobile devices.
MUST show Bank Logo, Legal Entity name, Bank Account Number and issue date no older than 3 months. Maximum document limit is 1MB
I confirm the uploaded documents shows*

Trust Document Upload

Document Upload - Trust Deed*
No File Chosen
File uploads may not work on some mobile devices.
Maximum document limit is 1MB

  

*We cannot proceed with your application as you have selected "No" to reviewing and acknowledging the terms and conditions.

*We cannot proceed with your application as you have selected "No" to reviewing and acknowledging the privacy statement

*We cannot proceed with your application as you have selected "No" to reviewing and acknowledging the privacy statement


 RETAILER DISCLOSURE:
 In signing below, I/We:

(a) confirm that I/We have read, understood and accept the Retailer Terms and Conditions on behalf of the Business, which will apply to this registration once approved by the Issuer;
 (b) understand that the details provided in this Retailer Application may be provided to a third party for the purposes of such checks
 (c) understand that to be approved as a Retailer, the Issuer and any of its related companies may provide the details provided above to a third party for the purpose of performing credit, fraud and AML/CFT due diligence checks, in accordance with the Privacy Policy for which I/We give my/our consent;

(d) where the above information relates to the personal information (as defined in the Privacy Act 2020) of other directors/ authorised persons of the Business, confirm that those persons have authorised me (on their behalf) to collect and provide such personal information to the Issuer in accordance with the Privacy Policy;
 (e)     confirm that the Business will not use the Issuer name, branding, logo or other identification without prior written consent from the Issuer.
 (f) confirm that the Business will ensure that we and/or our staff and sales representatives:

  • do not engage in any false or deceptive conduct in relation to the Issuer;
  • take all reasonable care to ensure the information provided by customers to the Issuer is true, complete and accurate;
  • do not mislead customers in any way about the nature or terms of the customer documentation;
  • follow the Issuer’s reasonable directions with regard to obtaining information from customers and fixing any errors or omissions in documentation;
  • observe any other instructions as may be advised to us from time to time;
  • indemnify the Issuer if we provide any false or misleading information to a customer which causes the Issuer to experience any loss;

(g) understand that the Issuer reserves the right to cancel an approved Retailer Agreement at any time, and with immediate effect, by giving notice in writing;
 (h) confirm that neither the Business nor any staff or sales representative will hold itself out to be an agent of the Issuer, and nothing in this Retailer Agreement constitutes a relationship of employer and employee, partnership or agent, between us and the Issuer or any of our staff or salespeople.
 (i) if I have signed this Retailer Application by use of electronic signature (including by signing on an electronic device or by digital signature) then I:

  • agree that the Issuer may rely on the electronic signature(s) as having the same force and effect as handwritten signature(s);
  • and unconditionally consent to any method used by the Issuer to identify the signatories and to confirm their intention to enter into a binding legal agreement.

 

RETAILER ACKNOWLEDGEMENT: Agreed and Executed for and on behalf of the Retailer

(Authorised Signatory): Signatures are required for each individual, Sole Trader, Partner or Director(s) whose personal information has been provided.


Name*
Position Held*
Use your mouse or finger to draw your signature above
Date*

Authorised Person to complete

In providing my personal details below I authorise for my information to be used to complete electronic verification of my identification*
Date of Birth*
Expiry Date*
Upload a certified copy of your Foreign Passport*
No File Chosen
File uploads may not work on some mobile devices.
Maximum document limit is 1MB
I confirm the Foreign Passport copy uploaded is certified*

Second / RETAILER / MERCHANT ACKNOWLEDGEMENT: Agreed and Executed for and on behalf of the Merchant

(Authorised Signatory): Signatures are required for each individual, Sole Trader, Partner or Director(s) whose personal information has been provided.


Name*
Use your mouse or finger to draw your signature above
Date*
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