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ONLINE ISO PROFILE The information provided on this document will serve to establish the scope of the proposed program. In this document, ‘CLIENT’ refers to the company deploying the card (ISO) and ‘CARDHOLDER’ refers to the customer actually using the product. Please fill in all areas that apply. Please complete the card program request below an submit and a representative from Direct Pay International or one of it's partners will contact you within 24-48 hours to discuss your interest further. If you would like to first understand the requirements for our card programs then click here for standard card program requirements or click here for customizable card program requirements.
Company Name
Trade Name or Business Name
Country	SELECT YOUR COUNTRY OF OPERATION Afghanistan Albania Algeria American Samoa American Virgin Islands Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Estonia Ethiopia Faeroe Islands Falkland Islands Fiji Finland France French Guiana French. Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (North) Korea (South) Kuwait Kyrgyz Stan Laos Latvia Lebanon Lesotho Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauretania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Niue Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda San Marino Sao Tome & Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands South Africa Spain Sri Lanka St. Helena St. Kitts-Nevis St. Lucia St. Pierre & Miquelon St. Vincent and the Grenadines Suriname Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay USSR Uzbekistan Vanuatu Vatican Venezuela Viet Nam Wallis and Futuna Islands Western Samoa Yemen Yugoslavia Zaire Zambia Restricted Countries
Company Website
Year of Company origination
Company's core business
Include details of any present card programs that you are offering or have offered
Primary Contact Name
Primary Contact Business Title	-- SELECT VALUE -- Mr Mrs Ms Miss The director The proprietor The Unknown Dr Signor Frau Signora Madame Monsieur
Primary Contact Direct Business Contact
Primary Contact Mobile Contact
Primary Contact Fax Contact
Primary Contact Email Address
Role in Implementation Process
Secondary Contact Name
Secondary Contact Business Title	-- SELECT VALUE -- Mr Mrs Ms Miss The director The proprietor The Unknown Dr Signor Frau Signora Madame Monsieur
Secondary Contact Direct Business Contact
Secondary Contact Mobile Contact
Secondary Contact Fax Contact
Secondary Contact Email Address
Role in Implementation Process
Programs of Interest	Prepaid Program Standard Private Label Visa Program         MasterCard Program  Maestro Program
Programs Type of Interest	Program Type Payroll   Money Remittance   Affinity   Retail   Incentive/Commission Pay Out
Summary of Program Scope and Functionality
Target Implementation Date
Please detail you end user card price strategy
Business Strategy	Business to Business         Business to Consumer
Targeted Marketing Demographics
Targeted Countries
Marketing Channels
Sales Process: Identify the method for the customer to apply for the product through your organisation i.e. website, direct mail, call centre, etc
Volume Projections It’s important to use reasonable forecasts that account for: A ramp-up period of approximately 12 months or more , Cardholder attrition. i.e. a payroll program for a 500 employee business may be over-projected at 3,000 cards Year 1 and should be adjusted to a more reason-able number. Program profitability can be significantly impacted by too high a projection.
Potential First Order Volume
Volume Projections for Q1 2006
Volume Projections for Q2 2006
Volume Projections for Q3 2006
Volume Projections for Q4 2006
What level of financial investment will your organisation be committing to the first 3 months of the program
Describe what form of ID you will verify prior to sending your clients application to CCS for processing, including the method of capture.	IMPORTANT: Current worldwide Anti-Money Laundering (AML) measures require that a minimum amount of information be collected on Cardholders including: name, date of birth, mailing address,   and a US taxpayer social security or other similar tax identification number or if non US then a Government issued/approved photo ID