Direct Merchant Services

Please fill out all sections, and give as much information as possible.

Merchant Information Details
Company Name
Registered Address
Country
Company URL
Telephone Number
Fax Number
Email Address
Please describe the exact nature of you business:
Application Services applied for:
What Is your Current/Anticipated Turnover and per transaction amount:
Where did you hear about us?: (If a search engine, please specify which one)
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Please note:
The information provided to us, will be treated in the strictest of confidence.

If posting or faxing the application form, please use the details shown:

Direct Merchant Services Ltd,
Suite 35
Burlington House
369 Wellingborough Road
Northampton
NN1 4EU
England

If you have any questions or queries regarding this application please call +44 (0) 1604 632308