PayHalal Payment Gateway Application s


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

A. ACCOUNT INFORMATION


Company Type:

Subscription Plan:


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):
*optional


E. DETAILS ON E-COMMERCE BUSINESS

*optional

F. DETAILS ON COMPANY BANK ACCOUNT


G. DETAILS ON TECHNICAL

*optional

H. DOCUMENT UPLOADS

*Maximum size for each document is 1MB

SSM Certificate:

Halal Certificate/ Halal Supporting Document:

Product Catalog (Download Excel Sample):

Domain Invoice:

*optional

Copy of IC or Passport:

*optional

Latest Bank Statement:

*optional

Letter of Authorization:

To Nominate Person In Charge handling PayHalal Merchant Account
*optional
*Accepts JPG/JPEG and PDF files only