thirdpartyserviceprovider(tpsp)application.docVIP

Third Party Service Provider* (”TPSP”) Application *Includes TPP, TPS, MS and DSE Submitted by: _____________________ Business Unit: _________________________ Date:__________ Direct or Non-Direct Connect? _____________________________________________ I. COMPANY INFORMATION TPSP Corporate (Legal) Name: Tax ID: TPSP DBA Name(s): Business Address (complete): Business Mailing Address (if different than above): Business Start Date: Website Address: Contact Person: Contact E-Mail: Can this person be contacted directly by credit at this time? Yes No Business Phone # (‘s): DB Number: Business Fax # (‘s): Parent Company (if any): Business Type: Partnership Public-Stock Ticker: Private Sole Proprietorship Prior company name (if applicable): II. ITEMS TO BE SUBMITTED WITH TPSP APPLICATION (Items 3-7 not required for Public-Stock Ticker Businesses) Completed N/A 1 Business Plan 2 Copies of sales materials, business card, sales brochure or website URL 3 Articles of Incorporation or Partnership Documents 4 Principals’ work history, resume 5 Copy of Principals’ Driver’s License 6 Bank statements 7 Two (2) years Audited Financial Statements Interim statements including PL and B/S 7a If a Start-Up Business, please provide the following: Financial Projection Plan Opening Balance Sheet 8 PCI Compliance Certification (ROC approval and AOC) If PCI Compliant at time of Registration: For Level 1: Executive Summary of ROC and AOC for Onsite Assessments For Level 2: Completed Self-Assessment Questionnaire If NOT PCI Compliant at time of Registration: For Level 1: MasterCard Action Plan and Self-Assessment Questionnaire For Level 2: Self Assessment Questionnaire 9 Executed and Approved Contract (if applicable) A Registration Fee Check may be required before going into production dependent on fees charged b