Prepaid Card Application Form

Intercash Merchant Application Form

Contact Information
First Name		Last Name
E-Mail		Title

Company Name		Website URL
Address		City
Country		Telephone
Postal Code		Mobile
Fax

Business Description

Please provide a detailed description of your business’ nature and activities:

Purpose of Card Services
Affiliate Compensation	E-Wallet	Loyalty/Giftcard
Employee Reward/ Incentive	Gaming Winnings	Other (Describe)

Where are the majority of your members located?
Country
Country
Projected Initial Card Order:

Are you interested in our check and EFT processing services?

Yes

Additional Comments :


Please enter the following code:

Intercash is an approved MasterCard ISO. Intercash cards are issued by Banque Invik, pursuant to a licence by MasterCard® International Incorporated. MasterCard®
is a registered trademark of MasterCard® International Incorporated.