Create New Account ! |
* Please fill out this form completely, and then press submit to continue.
* Click Here To find out
the procedure followed by CCAvenue , after you sign up this form.
* The following Sign up is for Visa, American Express, Diners Club International, JCB, Net Banking, Cash Card and Mobile Payments. For accepting Master Cards on your website Click Here |
| Contact Details |
| Contact Person's Name * |
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| Business Filing Status * |
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Mailing Address *
(Do not include Country) |
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| Country * |
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Phone No. *
(For CCAvenue use only. |
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| We do not display your phone number to customer.) |
| Fax No. |
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| (For CCAvenue use only. We do not display this number to customer.) |
| Email * |
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| Website Details |
| Website Name (URL) * |
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[ Ex- www.ccavenue.com ] |
| CCAvenue Account Type * |
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What is this?
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| Bank Details |
| Pay To * |
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This name will appear on our payment cheques issued by us to you.
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| Account Number * |
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| Bank Account Type * |
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Bank Name *
(Select from the list or
specify in this text box if not in the list) |
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| Branch Name * |
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| Branch City * |
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| Additional Details |
Owners/Promoters *
(Names, Age, Sex, EducationalQualifications, Residential Address and Financial Stake) |
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Angel / VC funding details
( If Any ) |
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| Brief Description |
Brief Description about your Company & Site * |
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| Product Description *
About Products & Services you intend to sell using our Payment Gateway |
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| Minimum cost of unit sold *
(in INR) |
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Rs |
| Average cost of unit sold *
(in INR) |
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Rs |
| Number of transactions * |
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per Month |
Logistics Partner Details *
(Details of how and through what mode you will deliver your Products/ Services.) |
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| Login Details |
Username *
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(5 to 8 characters long only.) |
| Password * |
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(5 to 8 characters long only.) |
| Re-enter Password * |
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What next ?
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