Payconiq by Bancontact

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Payconiq Merchant Contract

1
Contact Information
2
Company
3
Personal details
4
Products
5
Billing
6
Signature

* Unless stated otherwise, all fields on this form are mandatory.

Your Payconiq partner:

Payconiq België

I'm already a Payconiq customer

Contact person

This person is the primary contact person for Payconiq within your organization. This person will also receive admin rights when accessing the Merchant Portal.

Mr.

Ms / Mrs.

Other / I'd rather not share

First name

Last name

Phone

Enter your telephone number here with + and country code, without spaces. Example :+32227930143

This email address is used for (1) correspondence; (2) login as admin user to the merchant portal; (3) commercial messages* and this email address will receive a copy of this contract.

Check the box if you do not wish to receive marketing offers or information about similar products or services offered by Bancontact Payconiq Company NV by e-mail. Read our Privacy Statement on payconiq.be/en/privacy-statement-and-terms-conditions.

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