Forms Preview — Industra – A Bank That Understands Businesspeople

Authorized representative of the company:

Name, Surname: *

Phone: *

Е-mail: *

Company contact person

Name, Surname: *

Phone: *

Е-mail: *

Information on the use of POS terminals

Number of existing/planned trading places: *

Please provide the addresses of the trading places in the Appendix No. 1

Monthly turnover in EUR via POS terminal/s

Existing:

EUR

Планируемый:

EUR

None

Average size of one transaction in EUR: *

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Company representative:

(Signature)

(Date)

Accepted:

(Signature)

Additional information:

Appendix No. 1 to AS "Industra Bank" Trader's questionnaire

No. *

Address *

City *

Name of the trading place *

Contact person *

Phone *

Required device

Stationary / IP POS

Number of stationary/IP POS

Mini POS

Number of mini POS

vPOS

Моb. POS

Number of mobile POS's

Cash register

Number of cash registers

Self-service station

Number of self-service POS terminals

Add new

Уполномоченное лицо компании:

(Имя, Фамилия)

(Занимаемая должность)

I hereby consent to the processing of personal data.

* mandatory fields

Application for installing a POS terminal

Company information

Authorized representative of the company:

Company contact person

Information on the use of POS terminals

Appendix No. 1 to AS "Industra Bank" Trader's questionnaire