Sign Up - www.mintpayments.com

Choose your Mint products
Product Options*
- mPOS M10
- Move5000
- Virtual Terminal/ Hosted Payments Page (HPP)
- eCommerce
- Foreign Exchange (FX)
Pricing is as shown on the Mint Payments website or as negotiated & offered by our sales team.
Tell us about yourself
Director/Owner Name*
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 throughout the form.
Phone Number (Landline)*
Director/Owner Phone Number (Mobile)*
Director/Owner Email*
How did you hear about Mint?*
Tell us more*
Let us know who referred you, or how you came to hear about Mint
By clicking next, you agree to be contacted by one of our friendly staff members.

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Director/Owner Date of Birth*
Date Format: DD slash MM slash YYYY
Director/Owner Home address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Australia
What percentage of the business do you own?*
Please enter a number from 50 to 100.
Reminder: This application must be completed by an owner/ director with a share of at least 25% of the business/ company.
Have you ever declared bankruptcy?*
- No
- Yes
Bankruptcy discharge date*
Date Format: MM slash DD slash YYYY
We require one form of ID from the Director above. Please select your ID format that you can present.
Director/Owners Drivers Licence Number*
Passport Number*
Proof of ID Photo Card Number*

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Settlement account details

This is the account where payments you receive will be deposited into.
Account name (Settlement)*
BSB (Settlement)*
Account number (Settlement)*
Deductions account details

The account from which your fees will be deducted
Use the settlement details above.
- Use the settlement details above.
By ticking this box, I agree that the nominated settlement account above is to be used to deduct fees and direct debits.
Account name (Deductions)*
BSB (Deductions)*
Account number (Deductions)*
Is this a statutory trust account?*
- Yes
- No
What is the full name of the trust?*

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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
Would you like to join Mint Rewards?
- Yes
- No
Eligibility requirements apply, you can see full information and view the T&Cs on the Mint Rewards Page
Please nominate an email address for Rewards activation and allocation.*
Acknowledgements*
- 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 the relevant Mint Payments Acquirer & Partner Agreements and Terms & Conditions.
- I agree that Mint Payments can share the information contained in this application with it's partners where necessary to facilitate the provision of products and services that I have selected.
- I have read, understood and agree to be bound by the Mint Rewards Terms and Conditions , and understand that if I elect to opt in to Mint Rewards I must meet therelevant eligibility criteria.
- 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.
All agreements, terms and conditions (our own, partners and acquirers)here
Trust Acknowledgement*
- I understand and agree that the account is operated for the purposes and benefit of the Trust only
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Choose your Mint products

Tell us about yourself

Tell us about your business

Settlement account details

Deductions account details

Supporting Documentation

Owner Information

Beneficial Owner 1

Beneficial Owner 2

Beneficial Owner 3

Beneficial Owner 4

Directors and Controlling Persons

Director/ Controlling Person 1

Director/ Controlling Person 2

Director/ Controlling Person 3

Director/ Controlling Person 4

Terms & Conditions

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