Jellybean Demo Application - www.mintpayments.com

Choose your Products
Options*
- Online Payments
- Physical Terminal
How many terminals do you require?*
Please enter a number greater than or equal to 1.
Tell us about yourself
Director/ Owner Name (as in NRIC/ FIN)*
First Last
This application can only be completed by the owner or director that has 25% or more share of the business/company. This director's details must be continued in the form below.
Director/ Owner Job Title*
Director/ Owner Phone Number (Mobile)*
Director/ Owner Email*
Director/ Owner Residential Address*
Street Address Address Line 2 ZIP / Postal Code
Director/ Owner ID Number (as in NRIC/ FIN)*
Director/ Owner Date of Birth
MM slash DD slash YYYY
What percentage of the business do you own?*
Please enter a number from 1 to 100.

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Tell us about your business
Have you ever declared bankruptcy?*
- No
- Yes
Bankruptcy discharge date*
MM slash DD slash YYYY
Business Type*
Industry Type*
Describe your business*
Trading name*

eg. Mint Plumbing Services
Company Address*
Street Address Address Line 2 ZIP / Postal Code
Company Phone Number*
Company Website*

eg. mintplumbing.com
- Business Entity Name same as above
Business/Entity Name*

eg. Mint Pty Ltd
Business Unique Entity Number (UEN)*
GST Number*
Total Annual Turnover*
Please enter your approximate annual turnover. This can be a previous financial year figure.
Do you currently have a merchant facility?*
- No
- Yes

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Settlement account details

This is the account where payments you receive will be deposited into.
Account name (Settlement)*
Bank Name*
Routing Number/ Bank Branch Code (Settlement)*
Account number (Settlement)*
Deductions account details

The account from which your fees will be deducted
Same As Above
- Same as above
Account name (Debit)*
Routing Number (Debit)*
Account number (Debit)*

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Supporting Documents

Please include at least one of the following forms of government identification.
Driver's License or Photo ID Card (Copy or Photo) - as in NRIC/ FIN*
Drop files here or

Max. file size: 10 MB.
Only colour copy back and front will be accepted.
Bank Statement (copy or photo)*
Drop files here or

Max. file size: 10 MB.
Only colour copy back and front will be accepted.
Terms & Conditions
Links to all agreements, terms and conditions (our own, partners and acquirers) are located in our website footer on our home page here: www.mintpayments.com
*
- I have read, understood and agree to be bound by the Mint Sales Australia Pty Ltd (Mint) Terms and Conditions. I agree that those shall be the only terms of any contract entered into with Mint. I confirm that all the information contained in this application is true and correct and that any information subsequently provided in support of this application will be true and correct.
- I have read, understood and agree to be bound by Mint Payments Acquirer & Partner Agreements and Terms & Conditions. I confirm that I have read and understood the relevant terms available online (see link here).
- I hereby request and authorise Mint Australia Pty Ltd (Debit User No. 513441 & 252550) to debit my / our nominated bank account provided above through the Bulk Electronic Clearing System for any amount that Mint (Aust) Pty Limited may debit or charge in accordance with the terms and conditions set out in the Service Agreement. I acknowledge that this DDR is governed by the terms of the Service Agreement and is to remain in full force in accordance with the terms and conditions contained in that Service Agreement.
- Please keep me updated with news and offers from Mint Payments
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Save and Continue Later

Step 1 of 4

Choose your Products

Tell us about yourself

Tell us about your business

Settlement account details

Deductions account details

Supporting Documents

Terms & Conditions