PayHalal Payment Gateway Application Form


Note: Please fill up this service application form IN FULL! Incomplete application will not be processed

A. ACCOUNT INFORMATION


Company Type:

Subscription Plan:

Create your Login
Invalid Email Address
*Password Must be atleast 8 characters
*Password Must contain atleast 1 uppercase & lowercase
*Password Must contain atleast 1 number & special character

B. GENERAL INFORMATION

Select Payment Type:


Current MDR Rate:


Monthly Sales Volume


C. COMPANY PROFILE


D. CONTACT PERSON

Contact Person 1 (Business Development/Marketing):

Contact Person 2 (Business Development/Marketing):


E. DETAILS ON E-COMMERCE BUSINESS


F. DETAILS ON COMPANY BANK ACCOUNT


G. DETAILS ON TECHNICAL


H. DETAILS ON CUSTOMER SERVICE & EMAIL NOTIFICATION

Customer Service/Support:


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