Merchant Signup Form

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Business Names

Owner(s) or Officer(s)

Owner or officer #1

Owner or officer #2

Beneficial Owner #1

Beneficial Owner #2

Beneficial Owner #3

Beneficial Owner #4

Merchant Profile

Financial Information

Member Bank Information

Wells Fargo Bank, N.A., P.O. Box 6079, Concord, CA 94524 • Phone (844) 284-6834

Important Member Bank Responsibilities

  1. The Bank is the only entity approved to extend acceptance of Card Association products directly to a Merchant
  2. The Bank must be a principal (signer) to the Merchant Agreement.
  3. The Bank is responsible for and must provide settlement funds to the Merchant.
  4. The Bank is responsible for educating Merchants on pertinent Visa and MasterCard Rules with which Merchants must comply; but this information may be provided to you by Processor.
  5. The Bank is responsible for all funds held in reserve.

Important Merchant Responsibilities

  1. Ensure compliance with cardholder data security and storage requirements.
  2. Maintain fraud and chargebacks below Card Association thresholds.
  3. Review and understand the terms of the Merchant Agreement.
  4. Comply with Card Association rules.
  5. Retain a signed copy of this Disclosure Page
  6. The responsibilities listed above do not supersede terms of the online Merchant Agreement and are provided to ensure the Merchant understands some important obligations of each party and that the Visa Member - Wells Fargo Bank - is the ultimate authority should the Merchant have any problems.

Electronic Signature (E-Sign) and Uniform Electronic Transactions Act (UETA) Disclosure and Consent Agreement (“E Disclosure and Consent”)

This E Disclosure and Consent is provided in compliance with the Electronic Signatures in Global and National Commerce Act, 15 USC §7001, et seq. (“E-SIGN Act”) and the Uniform Electronic Transactions Act, as adopted by the various States. This disclosure relates to, without limitation, electronic fund transfers, the use of electronic signatures and the use and storage of “electronic records” as defined in the E-SIGN Act. This policy describes how Nuvei delivers communications to you electronically. Nuvei may amend this policy at any time by posting a revised version on it’s website. The revised version will be effective when posted by Nuvei. If the revised version includes a substantial change, Nuvei will provide you with thirty (30) days’ prior notice by posting a notice of the change on the website. 12345523 123456789 2.85% 0.25 25.00 15.00 2.85% .25 40.00 Agent8002-W-MBA-2018S10 Electronic Delivery of Communications By entering into and accepting the Agreement or Terms and Conditions to which this E Disclosure and Consent is attached you agree and consent to receive electronically all communications, agreements, notices, documents and disclosures relating to the Agreement or Terms and Conditions and your use of the website (collectively, “Communications”). Communications include agreements and policies you agree to (for example, and not by way of limitation, the Agreement, including the Privacy Policy), including updates to these agreements or policies; annual disclosures; transaction receipts or confirmations; statements and transaction history; and any other transaction information or other information related to the Agreement or the Website. Nuvei will provide Communications to you by posting them on the Website and/or by emailing them to you at the primary email address designated by you in the New Account Form.

Hardware and Software Requirements

In order to access and retain electronic Communications, you will need the following computer hardware and software: a computer with an Internet connection; current “web browser” that includes 128-bit encryption with cookies enabled; a current version of Adobe Acrobat Reader to open documents in pdf format; a valid email address (the primary email address designated by you in the processing application); and sufficient storage space to save past Communications or an installed printer to print them.

How to Withdraw your Consent

You have the right to withdraw your consent at any time. To withdraw consent, you may send an email to If consent is withdrawn, Nuvei reserves the right to discontinue your access to its properties, terminate any and all agreements with you, and/or charge you additional fees for cancellation.

Updating your Contact Information

You are responsible for keeping your primary email address on file with Nuvei up to date so that Nuvei can communicate with you electronically. You understand and agree that if Nuvei sends you an electronic Communication but you do not receive it because your primary email address on file is incorrect, out of date, blocked by your Internet service provider, or you are otherwise unable to receive electronic Communications, Nuvei still will be deemed to have provided the Communication to you. If you use a spam filter or other technology that blocks or re-routes emails from senders not listed in your email address book, you must add Nuvei to your email address book so that you will be able to receive the Communications Nuvei sends to you. You can update your primary email address or street address at any time through the Nuvei website. If your email address becomes invalid such that electronic Communications sent to you by Nuvei are returned, Nuvei reserves the right to discontinue your access to the Website, terminate any and all agreements with you, and/or deem any and all of your accounts with Nuvei as “inactive".

Merchant Application and Agreement Acceptance

By executing this Merchant Application and Agreement on behalf of the merchant described above (“Merchant”), the undersigned individual(s) represent(s), warrant(s), and acknowledges(s) that: (i) All information contained in this Merchant Application (“Application”) is true, correct and complete as of the date of this Application; (ii) If the Merchant is a corporation, limited liability company, or partnership, the individual(s) executing this Application have the requisite legal power and authority to complete and submit this Application on behalf of the Merchant and to make and provide the acknowledgements, authorizations and agreements set forth herein on behalf of the Merchant and individually; (iii) The information contained in this Application is provided for the purpose of obtaining, or maintaining, a merchant account for the Merchant with the Member Bank and Nuvei (“BANK”) and BANK will rely on the information provided herein in its approval process and in settling the applicable Discount Rate, Approved Average Ticket, and Approved Monthly Payment Card Volume; (iv) BANK is authorized to investigate, either through its own agents or through credit bureaus/agencies, the credit of the Merchant and each person listed on this Application; (v) BANK will determine all rates, fees and charges and notify Merchant of the approved fees and by Merchant's submission and acceptance of Merchant's first settled transaction; Merchant agrees to pay such approved fees, including those fees listed at section 5.7 of the Merchant Agreement; (vi) The Merchant Agreement will not take effect until Merchant has been approved by BANK and a merchant number has been issued to Merchant; and (vii) The undersigned has read and understood the Merchant Agreement, which is incorporated herein by reference and agrees on behalf of the Merchant to be bound by the terms of such Merchant Agreement. The Merchant on whose behalf this Application is being submitted acknowledges that if this Application is being submitted to Wells Fargo Bank as the Member Bank, Nuvei is also a party to this Merchant Agreement. In such case, Merchant acknowledges that Nuvei will rely on the representations and warranties set forth in this Application for Merchant Agreement and unless otherwise specified or prohibited by Association or applicable law, Nuvei will have all the rights of Wells Fargo Bank under this Merchant Application and Agreement. You have the option of accepting MasterCard credit cards, Visa credit cards, American Express credit cards, Discover credit cards, MasterCard signature debit cards (MasterMoney Cards) or Visa signature debit Check Cards), or debit cards issued by Discover. You may elect to accept any or all of these card types for payment. If you do not specifically indicate otherwise, your Merchant Agreement will be processed to cards (accept ALL MasterCard, Discover, American Express and Visa card types. Elected Visa, Discover, or MC card types NOT to accept:

Merchant acknowledges having read and agreed to the terms and conditions of the online Merchant Agreement. If Merchant was un able to access such agreement online, Merchant acknowledges having been provided a copy by Nuvei and having read and agreed to same.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: when you open an account, we may ask you for information that will allow us to identify you, including a copy of your driver's license or other identifying documents.

Bank Disclosure


"Merchant Application” means this Merchant Application between Wells Fargo Bank, Nuvei Technologies Inc. ("Nuvei") and Merchant. "Merchant Agreement" means this Merchant Application once approved and accepted by Wells Fargo Bank together with the Terms and Conditions of the Merchant Agreement found at


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#1 From Application - Signature

#2 From Application - Signature