Ezetap Contact Point verification Form

Date of Visit [ DD-MM-YYYY] First Visit Re visit

Merchant Legal Name

Merchant Name on the
Board ( DBA )
Business PAN Number
Business GSTIN
Business Address
Business Mobile Number
Alternate Mobile Number
Email
Owned Leased Rented Others
Shop Ownership
200 to 500 Sqft 500 to 1000 Sqft
Less than 200 Sqft Greater than 1000 Sqft

Size Of Premises
Proprietor Partnership Private Ltd Others
Business Structure
Low Average Good Excellent
Level of Inventory/Stock
Date of Start of Business
Operating in Same Premises
Since
Shabby / Bad Average Good Excellent
Appearance of premises
Number of Staff Employed
Number of Staff Noticed
Annual Turn Over
Business Sector/Category
Number of Devices Required
Proprietor / Partner /
Director / HUF / Others
Name
Residence Address
Mobile Number
Email
Currently Accepts Cards?
Product Costs Range
Name of Store
Manager/Cashier
Mobile number of Store
Manager/ Cashier

FOS Name and EMP ID: Merchant Seal and Sign

Mob: