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Access Bank Merchant Enrolment Form

Section 1 – Company Information




Section 2 – Business Information
Section 2b – Contact Information
Primary Contact
Secondary Contact
Section 3 – Location of Terminal
Location Contact Person Mobile Number Action
Section 3b – Attestation

I hereby attest that the information provided in this form is true and accurate. I/We confirm that I/we have read and understood the terms and conditions and accept same as binding on me/us.

Section 3c – (To be completed by account officer)
Customer Account Turnover in Last 3 Months

Section 4 – (To be completed by digital banking)

Digital Banking team to ensure full compliance with the risk profile below. Check to confirm compliance or non-compliance and provide comments if necessary.





Digital Banking Sign-Off
Section 5 – Merchant Agreement

This agreement is made on this day of in the year between Access Bank (Ghana) PLC of Starlets 91 Road, Osu-Accra (hereinafter referred to as “Access Bank” or “the Bank”, which shall unless the context otherwise admits include its successors-in-title and assigns) of the one part, and having its business address as (hereinafter referred to as “The Merchant”, which shall unless the context otherwise admits include its/his successor-in-title and assigns or heirs as may be applicable) of the other part.