BankVOD Enrollment Form

    Step 1
  • Complete all fields and “Submit Form”.
    Step 2
  • Upon submitting your enrollment you will be logged into your BankVOD account.
    Step 3
  • Next, click the 'Order a Verification' button and follow the basic steps to upload your verification documents via our PCI Certified secured portal.

ABOUT SSL CERTIFICATES		 SecurityMetrics for PCI Compliance, QSA, IDS, Penetration Testing, Forensics, and Vulnerability Assessment
Ia. COMPANY INFORMATION
Company Name:*  
If no Company Name please enter your name
Country:*
Address:*  
Address2:
City:*  
State:*
 
Zip:*
 
Main Phone Number:*
 -  -  
Contact First Name:*  
Contact Last Name:*  
Contact E-Mail:*   
Mobile Phone Number:*
 -  -  

Ib. BILLING ADDRESS
Attn:*  
Address:*  
Address2:
City:*  
State:*  
Zip:*  

II. EIN
EIN:

Billing Options
Option 1: Monthly Invoicing: All charges will be billed on a Monthly Basis:
 

(Payment due within 14 days of invoice.)

Option 2: To Pay By CREDIT CARD:
Payment type:



 *Credit Card Charges will appear on your statement under "Billing Solutions, Inc.". Inquiries, call 1-888-801-0091.
Cardholder's Name:
(first)
(last)
  
Credit Card Number:
- - -
 
Expiration Date (MM/YY):  /  
CVV:  
Address 1:  
Address 2:
City/State/Zip Code:
 
Email:  
Phone:  
 
III. TERMS AND CONDITIONS:
   
 
 

Note:* indicates required field 
 
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For questions regarding the process, please send an email to -[email protected]