Safaricom Copy
BUSINESS TO BUSINESS PAYMENTS SERVICE
Company profile.
Company Name: ..................................................................................................................................................................................................................................
Business Trading Name: ........................................................................................................................................................................................................................
M-PESA Business Number:………………………..........................................................................................................................................................................................
Contact Person name: ............................................................................................................................................................................................................................
Email Address:...................................................................................................... Contact Number: .....................................................................................................
Please provide information of the user you want created as the Administrator to get access to the Business Payments Service:
Administratorʼs User Name:…………………………………………………………………………………………………………………………………………………............................................
Administratorʼs Email:.............................................................................................................................................................................................................................
Administratorʼs Number:……………………….............................................................................................................................................................................................
Kindly indicate the list of LNM Head Office store No./Pay Bill/B2C Account/Agent Till authorized to initiate Business Payments Transactions.
Complete one per account:
LNM Till/ Name
Pay Bill/B2C
Account/Agent Till Number
LNM Till/ Name
Pay Bill/B2C
Account/Agent Till Number
LNM Till/ Name
Pay Bill/B2C
Account/Agent Till Number
LNM Till/ Name
Pay Bill/B2C
Account/Agent Till Number
Kindly indicate the list of LNM Head Office store no./Paybill/B2C Account/Agent Till authorized to receive Business Payments Transactions
LNM Till/ Name
Pay Bill/B2C
Account/Agent Till Number
LNM Till/ Name
Pay Bill/B2C
Account/Agent Till Number
LNM Till/ Name
Pay Bill/B2C
Account/Agent Till Number
LNM Till/ Name
Pay Bill/B2C
Account/Agent Till Number
LNM Till/ Name
Pay Bill/B2C
Account/Agent Till Number
LNM Till/ Name
Pay Bill/B2C
Account/Agent Till Number
LNM Till/ Name
Pay Bill/B2C
Account/Agent Till Number
Authorised Signatory:……………………………………………........................ Authorised Signatory:...............................................................................
Date:.................../.................../.......................................................... Date:....................../.................... ......................./..................................
Safaricom PLC I P.O. Box 66827-00800 I Nairobi I Kenya I +254 722 003 272 I [Link]
