BETA Referral Form - Card Pay from the AA

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Lead Form

Business Trading Name*
Contact First Name*
Contact Last Name*
Address (Incl postcode)*
Email*
Phone*
Expected Monthly Turnover*
BETA Rep Name*
BETA Rep Email*
New to Cards or Switcher?
- New to cards
- Switcher
Current Provider
- Elavon
- Worldpay
- Barclaycard
Supporting Information*
Upload Statements
I have read the following statement to the customer and the customer has agreed as follows:*
“Do you consent to the BETA giving your contact details to EVO Payments International, the provider of Card Pay so that they may use your details to contact you?’’
- Please tick box if consent given

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Card Pay from the AA

Scottish Provident Building,
Suite 330,
7 Donegall Square West,
Belfast, County Antrim,
BT1 6JH, United Kingdom

Legal

EVO Payments International GmbH, Branch UK, trading as Card Pay from the AA is licenced by the Federal Financial Supervisory Authority BaFin (Bundesanstalt fur Finanzdienstleistungsaufsicht) in Germany (BaFin-ID 50071564 and Bak no. 122963; register available at www.bafin.de) and deemed authorised and regulated by the Financial Conduct Authority (firm reference no. 653606) for the provision of payment services. Details of the Temporary Permissions Regime, which allows EEA-based firms to operate in the UK for a limited period while seeking full authorisation, are available on the Financial Conduct Authority’s website.

VAT ID no. GB196800481

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