We need to collect data on all Perx clients before an order can proceed (a process known as KYB or Know Your Business).
Can you please complete the following form with your company details.
Company Name *
Company Name
Company Registration Number *
Company Registration Number / TRN
Registered Address *
Registered Address
Trading Address (if different)
Additional Trading Address
Company Type *
Please select one
Public Listed Company
Private Limited Company
Designated Activity Company
Unlimited Company
Partnership
Charity
Club/Society
Sole Trader
Other (Please state):
Company Type Other
If company type not listed
Country of Incorporation *
Country of Incorporation
Date of Incorporation (if known)
Industry *
Please select one
Agriculture
Arms manufacturing & suppliers
Charities & not-for-profits
Construction
Cryptocurrency exchanges & virtual assets
Education
Financial services
Casino & gambling (including online gaming)
Healthcare
Hospitality
Legal Services
Manufacturing
Mining, quarrying & utilities
Money service business
Payday lending & high-interest consumer lending
Pharmaceuticals
Professional services
Retail
Religious organisations
Real estate
Technology
Tobacco production & distribution
Transportation & logistics
Other (please state)
Other Industry
If industry is not listed
Company Size *
Number of Employees
Country of Operation *
Select all that apply
Ireland
European Economic Area
Outside EEA
Trading Names (if any)
Trading Names
Planned Annual Spend *
Please enter the planned annual spend on Perx Rewards cards:
Cardholder Location *
Confirm if the cards will be issued to employees or card users in the EEA:
Yes
No
Type of Incentive *
Select all that apply
Customer Incentive
Employee Incentive
Sales Incentive
Market Research Incentive
Small Benefits Scheme
Source of Funding *
This is the origins of funds being used to fund the cards.
Revenue from sales of products/services
Other (please state)
Other Funding Source
List alternative source of funding
Method of Card Funding *
Will funding be from a bank account in the Company’s name in the EEA
Yes
No
Other Method of Card Funding
Explain why account is based outside of the EEA.
First Name *
Contact's First Name
Last Name *
Contact's Last Name
Job Title *
Contact's Job Title
Phone Number *
Contact's Phone Number
Company Email *
Contact's Company Email
Date *
Consent *
I confirm that the details above are correct and consent to Perx to processing my information.
Yes
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In some cases, you may be asked to provide additional information before the order can progress – we will let you know if this is the case.