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To register as a MoneyOne Agent, please complete the form below.

 

Business Statement
 
Type of business *:
Individual Partner LLC Corporation
Company Name *:
Trading Name(s) if any:
Nature of Business *:
Business Hours *:
From: To:
Tax ID *:
Country of Incorporation *:
Telephone / Fax *
Email Address *
Website Address *
 
General Business Information
Years at this location * Do you own this property? * Yes No
Term of Lease *
LandLord's Name * Telephone *
Insurance Co. * Liability *
Contact * Telephone *
Business Accountant * Telephone *
 
Compliance Information
Person who will be in charge of anti-money laudering program should applicant be approved.
Name * Telephone *
Address *
Does applicant agree to adopt MoneyOne's Anti-Money Laudering policies and *
procedures should applicant be approved? Yes No
 
 
Personal Statement
Name * Surname *
Gender *: Female Male
Home Address *
Driver Lincense nº
Home Phone Mobile *
E-mail *:
Marital Status * Spouse's Name
Have you ever owned another business? * Yes No Years
From: To:
Are you or your spouse currently employed? * Yes No
Company Name
Address
Contact Telephone
Have you or your spouse ever filed Bankrupt? * Yes No
Have you ever been arrested, indicted and/or convicted of any felony under local,
state, federal or foreign law? * Yes No
If yes, please write a detailed explanation:
Years at your home address * Own Rent Monthly Payment *
Name on the Title *
Property Address *
Current Value
Please list two personal references
Name *:
Address *:
Telephone *: Relation *
Name *:
Address *:
Telephone *: Relation *
 
I/We authorize MoneyOne and any consumer reporting agency or investigative firm employed by MoneyOne to receive and investigate any and all business and/or personal information about me/us relating in any way to my/our eligibility to become and remain an agent of MoneyOne, to make inquiries of all people mentioned above and others having knowledge of me/us conduct and qualifications as MoneyOne agent, all without causing any liability to MoneyOne whatever to arise therefrom.