Section 1 - Contact Information & Gifting Status
 
 
 
Account/Membership number (if known)
 
 
Account Name*
 
 
 
 
 
Trading Name (If different from account name)
 
 
Company Telephone*
 
 
 
 
 
Address Line 1*
 
 
 
 
Address Line 2
 
 
Postcode*
 
 
 
 
 
First Name*
 
 
Last Name*
 
 
 
 
 
Contact Email*
 
 
Contact Telephone*
 
 
 
 
 
Job Title
 
 
 
 
 
 
 
 
Is this premise already participating in the gifting scheme? **
 
 
 
 
 
 
 
 
 
 
 
Section 2 - Current Till Integrations at this Premise
 
 

Please note: if you are not using one of the epos providers listed below, terminal/s will need to be installed to participate in the scheme.

 
 
 
 
Please select your EPOS provider*
 
 
If your EPOS is 'other' please specify
 
 
 
 
 
 
 
 
 
Section 3 – Terminal installations
 
 
 
If you provided your epos provider on the previous form, please skip this section. 
 
 
 
Primary Contact for terminal Install
 
 
Primary Contact number for terminal install
 
 
 
 
 
Opening Hours
 
 
How many till points do you have?
 
 
 
 
 
Do you have an internet connection at the till point?
 
 
 
 
 
 
Internet Connection Type
 
 
This information should be available from your internet service provider. 
 
 
 
IP Address, Gateway & Subnet Mask
 
 
This information should be available from your internet service provider. 
 
 
 
Spare plug socket/s availability
 
 
Is there a spare plug socket available at the till point/s to accommodate the terminal/s required? 
 
 
 
Spare connection port/s availability
 
 
Are there spare ethernet connection port/s available at the till point/s (within 3-5 meters to accommodate the terminal/s required? 
 
 
 
Other on-site requirements
 
 
Is there anything else the epay engineer would need to be aware of on site?  
 
 
 
 
 
Section 4 - Payment Information
 
 
 
We require a completed Direct Debit instruction from you to allow us to collect money owed from the activation of gift cards.  Please either download or print the Direct Debit instruction, complete, sign and either upload below, send to us via email or post.  Our address can be located on our website.

You will need to provide the bank account details in a separate email to services@hta.org.uk if you wish for this to be paid into a different account please tick below.

Download Direct Debit form

 
Direct Debit Upload (please ensure file name has no special characters, e.g. commas, hyphens)
 
 
 
 
 
The money owed from redemption of gift cards and vouchers is paid by BACS to the bank account details provided on the Direct Debit instruction. If you wish for this to be paid into a different bank account please provide the bank account details in a separate email to services@hta.org.uk

If you wish for this to be paid into a different bank account please tick below: 
 
 
 
I wish to be paid into a different account
 
 
 
 
 
 
 
Section 5 - Submit your application
 
 
 

We will get back to you on your application within 5-10 days. It may be necessary for us to contact you to clarify aspects of the application.

In the meantime, please do not hesitate to contact the Services Team on services@hta.org.uk for any outstanding questions you may have.