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Multi Merchant New Facility Form - Hicaps 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the Provider Details section. Enter your profession or specialty, title, given name(s), surname, and registered company name if applicable. Ensure you provide your ABN and the terminal receipt name.
- Next, complete the Site Address section with the location address of the terminal, including state, phone number, mailing address, and email.
- If applicable, provide your Medicare Australia provider number based on your profession. For dentists and other specified health providers, this is mandatory.
- In Section B, indicate whether you are an existing health provider and fill in your details accordingly.
- Proceed to Section C for Bank Details. Include a deposit slip or bank statement to validate your account information. Ensure that the account can be credited and debited by a third party.
- Finally, complete Section D by signing the terminal owner’s declaration and indicating if you require additional credit facilities linked to your HICAPS terminal.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2016 | 4.8 Satisfied (201 Votes) |
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