Corporate Form – PRETpayments

Overview

Business Name

Business Overview

Full Address

Operational Countries

Email (for confirmations)

Phone

Website

Tax Identification Number

Date of Incorporation

Type of Business (Must Select One)
Individual/Sole Proprietor or Single-Member LLCCorporationTrust/Estate
Is the Applicant (Check all the apply)
REITNon-Profit or NGOMoney-Service BusinessFinancial InstitutionCrypto ExchangeNot Applicable

Account Purpose

Please Describe the Flow of Funds

Monthly FX Volume

Purpose of Payments

Currencies Needed (Please list all that apply)

Monthly Transaction Count (per currency)

Services Required (Acceptance, Banking, Payments)

Preferred Settlement Method

Method of funding PRET for execution: Wire “push”ACH Pull (authorization required)ACH PushStablecoinPRET Minimum Balance Account

Preferred Settlement Currency(s);

Average Transaction Size

Bank Name

Full Bank Address

Account Number

ABA Number/Routing Code

Minimum Requested Balance for Account (not required)

Crypto Wallet Provider(s) (not required)

**Note that when paying by ACH debit or check/fax check methods funds may be subject to a holding period which can be avoided by paying by wire**

Authorized Users

Name

Title & User Role

Phone

Name

Title & User Role

Phone

Name

Title & User Role

Phone

Name

Title & User Role

Phone

Beneficial Owners (Only 25% +)

Name

Date of Birth

Ownership Percentage & Primary Citizenship

Name

Date of Birth

Ownership Percentage & Primary Citizenship

Authorization (Must be an authorized signer)

All Transactions under the Agreement are facilitated by a licensed money transmitter which partners with or directly sponsors PRETpayments, Inc. The Applicant authorizes PRETpayments, Inc to open an account for global payment transactions with a licensed money transmitter in the applicable jurisdiction. The applicant certifies that the information set out in this Application is correct and complete and the individual signing this Application has the requisite authority to bind the applying business. By signing below, the Applicant certifies that it has read, understood, and agrees to the PRETpayments terms and conditions found on our website.

Name (Please Print)

Title

Signature

Date