Payment Gateway Get Exclusive Payment Gateway from Navotar Fill out the form below to start today! Name of Entity (Legal Name) City State / Province Telephone # (Landline) Business Site URL Corporate / Billing Address Country ArubaAfghanistanAngolaAnguillaÅland IslandsAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntarcticaFrench Southern TerritoriesAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBonaire, Sint Eustatius and SabaBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaSaint BarthélemyBelarusBelizeBermudaBolivia, Plurinational State ofBrazilBarbadosBrunei DarussalamBhutanBouvet IslandBotswanaCentral African RepublicCanadaCocos (Keeling) IslandsSwitzerlandChileChinaCôte d'IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCuraçaoChristmas IslandCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaWestern SaharaSpainEstoniaEthiopiaFinlandFijiFalkland Islands (Malvinas)FranceFaroe IslandsMicronesia, Federated States ofGabonUnited KingdomGeorgiaGuernseyGhanaGibraltarGuineaGuadeloupeGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGreenlandGuatemalaFrench GuianaGuamGuyanaHong KongHeard Island and McDonald IslandsHondurasCroatiaHaitiHungaryIndonesiaIsle of ManIndiaBritish Indian Ocean TerritoryIrelandIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJerseyJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, Republic ofKuwaitLao People's Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMacaoSaint Martin (French part)MoroccoMonacoMoldova, Republic ofMadagascarMaldivesMexicoMarshall IslandsMacedonia, the former Yugoslav Republic ofMaliMaltaMyanmarMontenegroMongoliaNorthern Mariana IslandsMozambiqueMauritaniaMontserratMartiniqueMauritiusMalawiMalaysiaMayotteNamibiaNew CaledoniaNigerNorfolk IslandNigeriaNicaraguaNiueNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPitcairnPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People's Republic ofPortugalParaguayPalestine, State ofFrench PolynesiaQatarRéunionRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSouth Georgia and the South Sandwich IslandsSaint Helena, Ascension and Tristan da CunhaSvalbard and Jan MayenSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSaint Pierre and MiquelonSerbiaSouth SudanSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSint Maarten (Dutch part)SeychellesSyrian Arab RepublicTurks and Caicos IslandsChadTogoThailandTajikistanTokelauTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUnited States Minor Outlying IslandsUruguayUnited StatesUzbekistanHoly See (Vatican City State)Saint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, BritishVirgin Islands, U.S.Viet NamVanuatuWallis and FutunaSamoaYemenSouth AfricaZambiaZimbabwe Postal Code Email ID: How Long in Present Business? (Years / Months) Authorised Contact Name Visa/Mastercards Card Swipe E-Commerce Average Ticket VISA / DISCOVER / MASTERCARD Monthly Volume Amex AMEX Monthly Volume High Ticket AMEX Average Ticket Opt out of AMEX Marketing Communication MO/TO QUESTIONNAIRE 1.What percentage of sales are to: Business Clients? Individual Consumer? 2.Method of Marketing Other 3.Ecommerce Merchants - % of customer base: %US %Canada %Other 4. Visa/Mastercard/Discover card sales are charged to the card on: if Other (Specify): YesNo 5. Do you require deposits? YesNo If yes, % of total sales: OR Flat fee: Is Final payment due before fulfillment? YesNo If yes, how many days before final delivery? 6. Does any of your billing or marketing strategy involve negative response, or automatic billing? YesNo If yes, explain: 7. Do you offer a product/Service Warranty or Guarantees? YesNo If yes, is it 8. If Refund, is it: Other 9. Does your business charge recurring billing to customers? YesNo 10. Does your business offer up-sells? YesNo If yes, please provide the company names associated with the up-sells: 11. How is the card payment information entered into the payment system? Other. 12. If credit card payment information is taken over the Internet is payment channel encrypted by SSL or better? 13. Do you own the product/inventory? YesNo Is the product stored at your business location? YesNo If No, where is it stored? 14. Who ships the product? Contact Name: Phone Number Zip Plus4 City State Street Number Street Name Unit Designator Unit/Suite/Apt/Floor 15. Method of Delivery If Other: 16. How long after payment is product delivered?% of Sales in Same Day % of Sales in 1-3 Days % of Sales in 4-7 Days % of Sales in 8-14 Days % of Sales in 15-30 Days % of Sales in 30+ Days Merchant Certificate # Certificate Issuer Expiry Date