BRANCH

ENROLLME
NT FORM
Corporate Name*
Account Manager*
Industry*
Sub-Category*
BRANCH ADDRESS TYPE OF TRANSACTION REPORTS, EMAIL RECIPIENTS AND MERCHANT PORTAL ACCESS BANK SETTLEMENT SMS NOTIFICATION KIT INCLUSIONS
MERCHANT PORTAL

Leave Behind EMV Mastercard

Number of QR Mall / Building Name Authorized Representative/s to Contact Details of Authorized Representative/s to Authorized Representative to Contact Details of Authorized Representative/s to MOBILE NUMBER 1 MOBILE NUMBER 2 QR BILLFOLD QR ID and Other material requests COMPLETE DELIVERY
No Brand Name Branch/Location Branch Code Terminal ID/s Branch Display Name (Main)
Keycards
Unit No. / Floor No. / Street Name
(e.g. Ayala Malls Trinoma)
Barangay / Subdivision / Village City / Municipality Region / Province Zip Code SUBSIDIARY-LEVEL ACCESS MERCHANT-LEVEL ACCESS BRANCH-LEVEL ACCESS SETTLMENT EMAIL RECIPIENTS BRAND EMAIL RECIPIENTS BRANCH EMAIL RECIPIENTS FREQUENCY OF EMAIL REPORTS NAME OF BANK BANK ACCOUNT TYPE BANK ACCOUNT NAME ACCOUNT NUMBER
APPROVE REVERSALS
Designation of Authorized Representative
APPROVE REVERSALS RECEIVE KITS RECEIVE KITS (if applicable)
DIGITAL QR QR KEYCARD
STICKER LANYARD
Mobile Phone SIM Door Hanger Material (for long tail use DELIVERY METHOD
ADDRESS
TRAINING AND DEPLOYMENT
(FAQs) (Please indicate type of material)
only)
Terminal ID may be used by partner. If no Merchant Name to be seen by customers in
Branch Code may be used by partner. If no Indicate email address/es per user access Indicate email address/es per user access Indicate email address/es per user access Indicate email addresses of CORPORATE Indicate email addresses of BRAND level Indicate email addresses of BRANCH level
Unique Indicator of the location of the branch (ex. input, GCash to assign a value. 1 terminal QR standee, app, and SMS. Value should Fill up only if by Delivery
input, GCash to assign a value. To be level. Use semicolon ";" to separate multiple level. Use semicolon ";" to separate multiple level. Use semicolon ";" to separate multiple level TRANSACTION REPORTS. Use TRANSACTION REPORTS. Use TRANSACTION REPORTS. Use semicolon ";" Indicate all representatives per branch who will be able to authorize Only reversal requests coming from these contact details will be Mobile numbers to receive real-time notifications, must be Globe/TM Who will be assigned to train and
Brand Name or Trade Name Mynt Store Makati, GCash Store QC, GCash ID is for 1 unique QR per branch. To be be unique and max of 25 characters (Also Count of QR Daily, Weekly, Monthly Personal or Corporate Indicate requested quantity per material
Store Greenbelt)
reflected in reports. maximum 15
reflected in reports. Must be 8 applicable for Stores with more than one
emails. emails. emails. semicolon ";" to separate multiple emails. semicolon ";" to separate multiple emails. to separate multiple emails. reversal requests accommodated (Indicate number given by merchant or if provided by GCash) Method is LBC DELIVERY depoy kits to Merchant?
alphanumeric characters in length Type N/A if not applicable. Type N/A if not applicable. Type N/A if not applicable. Type N/A if not applicable Type N/A if not applicable Type N/A if not applicable
alphanumeric characters in length counter)
1
2