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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?
Yes
No
Are you a Wallet Service Provider?
Yes
No
Wallet Service Provider Comments
Is the Crypto of the End User held in a Hot or Cold Wallet?
Hot Wallet
Cold Wallet
Hot or Cold Wallet Comments
Is the Private Key held by the End User?
Yes
No
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
BCH
BTC
ETH
LTC
XRP
Others
Crypto currencies that can be purchased by fiat
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?
Yes
No
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?
Please select...
1
2
3
4
Does the contact person is the owner?
Yes
No
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
Your information will be used in accordance with our
Privacy Policy
Interested in becoming a Simplex partner?
Let’s get in touch
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