1.

Company Information
Registered Name
Trade Name
Registered Address
Mailing Address
Office Phone Number
Company Website
Registration Number
Years in Business
Ownership Type
Nature of Business
2. Contact Details
Name
Office Number
Fax Number
Residential Address
Name
Position/Title
Office Number
Mobile Number
Email
3. E-Commerce Site Information
URL
Tech Platform
Types of Items Sold
Target Market
Est. Monthly Sales
Plan
4. Settlement Instructions
Bank
Account Type
Tax Identification No.
Single Proprietorship Partnership Corporation Non-Profit Government
Merchant Application Form
Dragonpay Corporation, Suite B, 5/f Builder's Center Building, 170 Salcedo Street, Legaspi Village, Makati City, Philippines 1200
Paid-up Capital No. of Employees
Office Fax Number
Name
Position/Title
Mobile Number
Email
Email
Mobile Number
Position/Title
Office Number
Signatory
Technical Support Billing
http://
Ave Txn Amount Max Txn Amount
Standard Micropayments
Branch Name
Account No. Savings Checking
Tel: +63(2)975-1111 Fax: +63(2)840-4434 loc 136 Email: sales@dragonpay.ph Web: http://www.dragonpay.ph
Remarks
Wire Instructions