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Merchant Registration Form
MERCHANT INFORMATION:
Business Name:
Registration Number:
PIN:
Trade name:
Business Type:
Church
Individual
Limited Liability Company
Non-Govermental Organisation
Sole Proprietorship
Business Sector:
Bar and Restaurant
Beauty Products
Book Shop
Catering Services
Clothing and Fashion
Distributor/Stockist
Electrical Items
Electronics
Fuel Station
Hotel/Guest House
Jewelry
Laundry Services
Resturant
Salon
Store/Supermarket
Telecoms
Vehicle accessories
Wholesaler
If OTHER, please type:
MAIN ADDRESS:
Physical Address:
Postal Address:
Postal Code:
City:
Country:
';
Kenya
Tanzania
Uganda
OTHER
BANK ACCOUNT:
Bank Name:
NONE
Branch 1
Branch 2
Branch 3
Branch 4
Branch:
NONE
Branch 1234567890
Branch 2
Branch 3
Branch 4
Account Number:
Account Name:
PANGO SYSTEM MANAGERS DETAILS:
Manager Name:
Designation:
Mobile Number
Prefix:
Number:
e-Mail Address
Manager Name:
Designation:
Mobile Number
Prefix:
Number:
e-Mail Address
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