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Onboarding Merchant Form
If you have any questions or would like
to learn more about our insurance payment gateway,
please contact us using the form below
Entity Legal Name
Entity Legal Name is required.
Merchant Brand Name
Merchant Brand Name is required.
Business Entity Type*
—Please choose an option—
Private
Public
Non-Profit
Business Entity Type is required.
Category/Segment
—Please choose an option—
Insurance
Finance
E-Commerce
Category/Segment is required.
Website URL (Live)*
Website URL is required.
Address*
Address is required.
City*
City is required.
State*
State is required.
Pincode*
Pincode is required and must be a 6-digit number.
Email Address*
Domain Email Address is required. (@gmail.com, @yahoo.com, @co.in, @rediffmail.com is not allowed)
Send OTP
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