1800 MR ATMS
MANDRAKE.ATM Approach
Disputed ATM transactions
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Merchant Detail Form
If you like to sign up for any of our EFTPOS terminals/packages, please fill out the form and click on the "Submit" button below. Please read our Privacy Statement before submitting your application. Filling out all fields will help us provide you with the best EFTPOS solution for your business.

Full legal name of business:
 *
Trading Name:
 *
ABN:
 *
ACN:
Trading address:
 *
Postcode of trading address:
 *
Mailing address:
 *
Postcode of mailing address:
 *
Contact name:
 *
Telephone number:
 *
Mobile number:
Fax number:
Email Address:
 *
Website address of your business:
Full description of business:
 *
Do you have an existing merchant facility? (Tick the applicable below).
 *
Yes
No
If yes please provide a copy of your merchant statements with this form.
Copy of merchant statement
Please upload a scan of your latest merchant statement here.
Please provide AMEX Diners and JCB numbers below if you have them:
AMEX:
Diners:
JCB:
BSB and account number to credit funds to:
BSB:
 *
Account Number:
 *
BSB and account number to debit fees from:
BSB:
 *
Account number:
 *
Transaction details:
Average transaction size $:
 *
Total annual business turnover $:
Please provide an estimate for all three figures.
Comments:
Security code:
 *
Do not enter anything in this field:

* indicates a required field


    Mandrake.ATM

    Level 26, 44 Market St, Sydney 2000 NSW  
    PO Box 545, Darlinghurst NSW 1300 Australia
    1800 MR ATMS (1800 672 867)
    Tel: +61 2 9089 8850 
    Fax: +61 2 9089 8893
    sales@mandrakeatm.com
    inquiries@mandrakeatm.com 

     A.C.N.: 111 571 076, A.B.N.: 72 111 571 076. 

    Member of:


    All text COPYRIGHT © MANDRAKE.ATM 2004-2013 unless specified otherwise. COPYRIGHT AND DISCLAIMER.  
     
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