NetCommerce Secure Payment Gateway
 Secure, Fast & Easy E-Commerce NetCommerce payment gateway provides complete, simple and secure online payment services with real time credit card transaction validation
Thursday, October 28, 2021   
Application Form
Please, fill-in and submit the below Sign UP Form in full details.


(*) Required Field
Company Info 
 Company Name*
 Commercial Register no/ acknowledgment and location*
 Date & Place of Commercial Registration / acknowledgment*
 VAT Code*
 M.O.F Number*
 Business Type*
 Local Bank Names You Deal With/Branch*
 List the company main activities*
Max. 200 characters
 Country*
 City*
 Full Address*
Max.100 characters
 Po Box
 E-Mail*
 Telephone*
 Fax
Authorized Signatory 
 First Name*
 Father's Name*
 Family Name*
 Mother's Name*
 Nationality*
 Other (Maiden Name)
 Email*
 Mobile or Tel*
 Tick here if the manager is in charge of the operations, technical and financial notifications
Your Company Representative for Operations & Activity Notifications 
 First Name*
 Last Name*
 E-Mail*
 Tel or Mobile*
Your Company Representative for Financial Notifications 
 First Name*
 Last Name*
 E-Mail*
 Tel or Mobile*
Website Development Company / Developer 
 Company Name
 First Name*
 Last Name*
 
 E-Mail*
 Tel or Mobile*
Website Info 
 Merchant Website URL*
 Other URLs Used for the Same Website
Max. 200 characters
Products and Services Sold on Your Website 
 Description*
Max. 200 characters
 Type of Delivery*  
 Minimum Amount Expected Per-Transaction* $
 Maximum Amount Expected Per-Transaction* $
 Highest Monthly Volume Expected* $
Payment Mode 
 Currency Used  
Bank Details
 Beneficiary Name
 Bank Name
 Branch
 IBAN  USD
   LBP
IBAN: International bank account number, Ex: LB10 0053 00CA USD0 0465 1234 56781
Please refer to your bank for info.
How did you know about NetCommerce? 
Notes
  I Hereby Certify all the information in this application are correct. I also authorize NetCommerce and /or any of its affiliates to verify any information included in this application.