Temporary-Merchant-Terminals-form

PURPOSE OF THIS FORM

For the authorised signatories of the below named client to request Temporary Merchant Terminals as specified in Section 2 of this Authority.

INSTRUCTIONS FOR COMPLETION

All fields are mandatory and must be completed by two authorised account signatories.
Fees and charges apply. Please contact the CDF for the fee schedule relevant to your product.

SECTION 1 – CLIENT DETAILS

Client Name*

Member No*

Business Address*

Business Postcode*

Postal Address*

Postal Postcode*

Phone*

Email*

SECTION 2 – MERCHANT TERMINAL DETAILS

Contact Name*

Contact Number*

Merchant Number*

CDF Settlement Acc*

Terminal Type*

Number of Terminals*

Delivery Date (required by)*

Collection Date (return)*

SECTION 3 – AUTHORITY

We, the below authorised signatories approve the request for the Temporary Merchant Terminals as listed in Section 2 of this form and acknowledge the associated fees.

Name of Authorised Person 1*

Name of Authorised Person 2*

Position of Authorised Person 1*

Position of Authorised Person 2*

Signature of Authorised Person 1*

Signature of Authorised Person 2*

Date (Authorised Person 1)*

Date (Authorised Person 2)*

Disclosure Statement | Privacy Collection Statement

TEMPORARY TERMINALS 2026/09

Request for Temporary Merchant Terminals

PURPOSE OF THIS FORM

INSTRUCTIONS FOR COMPLETION

SECTION 1 – CLIENT DETAILS

SECTION 2 – MERCHANT TERMINAL DETAILS

SECTION 3 – AUTHORITY