e-Path Gateway Application

Congratulations on choosing the e-Path credit card payment gateway.

Please complete this single page online application form. Once you have completed this section you will be taken to our secure e-Path payment page - the system soon to be making online credit card payments possible for your business too!!

Apply for the e-Path Credit Card Payment Gateway Service:

1. Select Gateway Type:
	Submit Secure - Single Licence Single Licence $242.00 AU$ incl GST - Yearly Fee $22.00 AU$ incl GST one time - Registration TOTAL: $264.00 AU$ incl GST
	Submit Secure - Multiple Licence Multiple Licence $330.00 AU$ incl GST - Yearly Fee $22.00 AU$ incl GST one time - Registration TOTAL: $352.00 AU$ incl GST
	Submit Direct - Single Licence Single Licence $242.00 AU$ incl GST - Yearly Fee $22.00 AU$ incl GST one time - Registration TOTAL: $264.00 AU$ incl GST Plus - $176.00 AU$ incl GST one time - Decrypt Program Decryption program paid under separate cover
	Submit Direct - Multiple Licence Multiple Licence $330.00 AU$ incl GST - Yearly Fee $22.00 AU$ incl GST one time - Registration TOTAL: $352.00 AU$ incl GST Plus - $176.00 AU$ incl GST one time - Decrypt Program Decryption program paid under separate cover

2. Gateway Usage:
Your Website URL:
Other URL's (if applicable):
e-Path Payment Alert Emails To:

3. Your Details:
Your Name:
Your Email Address:
Land Based Phone Line:
Land Based Phone Line Address:
Mobile (if applicable):

4. Your Business Details:
Business Name:
ABN (if applicable):
Land Phone:
Fax (iffapplicable):
Mobile (if applicable)
Street Address:
Suburb/Town/Province:
Postcode/Zip:	State:
Country:

5. Your Merchant Account:
Bank Name:
Branch Location:
Account Name:
Credit Cards Accepted: (Cards your merchant account has been set up to accept)	Visa  American Express  Discover  Mastercard  Diners Club  JCB
Other Credit Cards Accepted:
Is your merchant account approved to allow you to manually charge card-not-present credit card payments you receive online?	YES

6. Legal Requirements:
Do you understand e-Path's Requirements?	YES   e-Path Requirements
Do you understand and agree to the e-Path TOS & MA?	YES   Terms Of Service/Merchant Agreement
Do you agree to the e-Path Merchant Refund Policy?	YES   e-Path Merchant Refund Policy

7. Send Application Now:
Click To Send:

IMPORTANT: e-Path should be extremely easy to integrate into any website or shopping cart. However, if you have doubts we provide a live test URL that you can work with before you commit to making an application for an e-Path service - just to be sure. Please view e-Path Integration.

Please Note:

1. The submitting of this form and authorising payment for service does not constitute the application approval.
2. All applications are pending approval of e-Path Pty Ltd.
   
3. Your credit card will be charged upon application approval only.
4. In some circumstances it may be necessary for e-Path to request further information to facilitate the processing of applications.
   

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	This website makes no determination as to the suitability of the e-Path service for your particular personal or business needs. e-Path is an Australian based global provider of the e-Path Internet Credit Card Payment Gateway Service. All Rights Reserved - Copyright 2005, 2006, 2007, 2008 E-PATH PTY LTD ACN:124032917 | ABN:70124032917