Vertu Building, 12 Kerry Road Archerfield Q 4108

Tel: 1300 228 876 | sales@surpass.com.au

Preview only — open this form from the application link we email the customer to enable submission.

Eftpos Application

Surpass Business Solutions Pty Ltd

Part A - Business Details

Company Name *

Business Name *

ABN *

Must be 11 digits (0/11 entered)

ACN (optional)

An ACN is your company number, usually the last 9 digits of your ABN. Leave blank if you don't have one.

Shop / Unit / Street No. *

Street Name *

Suburb *

State *

Business Phone *

Landline area code, then the number

Business Mobile *

Year Company Established *

Part B - Owner & Contact

Owner Name *

Owner Title *

Owner Driver Licence Number *

Contact Name *

Title *

Mobile Number *

Email Address *

Part C - Bank Details

These are the bank details the payment terminal provider will deposit your card settlements into, so please provide your main business bank account — not a personal or secondary account.

Which bank? *

Bank Branch Suburb *

BSB *

Account Number *

Part D - Supporting Documents

Please upload clear copies. Documents are stored privately and only used to assess your application.

Driver Licence (Front) *Choose file

Driver Licence (Back) *Choose file

Bank Statement (latest 3 months) *Choose file

PDF preferred

This business operates under a trust