Stronger together

Partners

Customer Onboarding Form

General Information

Registered Business Name

Business Brand Name

Company Registration Number

VAT Number

Number of Employees

Business Start Date

Do you hold or are you planning to apply for an authorization or a license with a financial regulator? If yes, please specify what type of authorization/license

Articles of Incorporation

Crypto-currencies Activity

What is your current or expected number of credit/debit card transactions per month?

Have you accepted credit cards in the past/today?

YesNo

Are you a Wallet Service Provider?

YesNo

Wallet Service Provider Comments

Is the Crypto of the End User held in a Hot or Cold Wallet?

Hot WalletCold Wallet

Hot or Cold Wallet Comments

Is the Private Key held by the End User?

YesNo

Private Key Comments

Do you have security measures in place in order to protect your end users' crypto?
If so, please provide details

Do you have a plan in order to cover lost funds if crypto is stolen from your system?
If so, please provide details

Other Crypto-currencies

Crypto currencies planned for future trade

Business Model

Please describe in details what is your company's business model - what the company has been doing until now?

Please describe in details how do you see the business model and funds flow in cooperation with Simplex

What is your website address to work with Simplex?

Does your company have other websites?

YesNo

Name the websites addresses

Business Details

Company's Full Operational Address

Company's Full Registered Address

Business Phone Number

Contact Person Information

Contact First Name

Contact Last Name

Contact Email

Contact Phone

Contact Full Address

Contact Title at the Company

Business Owner / Founder Information

Number of owners the business has?

Does the contact person is the owner?

YesNo

Owner First Name

Owner Last Name

Owner Email

Owner Phone

Owner Full Address

Second Business Owner / Founder Information

Second Owner First Name

Second Owner Last Name

Second Owner Email

Second Owner Phone

Second Owner Full Address

Third Business Owner / Founder Information

Third Owner First Name

Third Owner Last Name

Third Owner Email

Third Owner Phone

Third Owner Full Address

Forth Business Owner / Founder Information

Forth Owner First Name

Forth Owner Last Name

Forth Owner Email

Forth Owner Phone

Forth Owner Full Address

Your information will be used in accordance with our Privacy Policy

Contact Information