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myBills Live Environment Merchant Account Request Form
Create Provider / Amend Provider
Merchant account is already configured in GPG and will be used in parallel with myBills HPP
Request Date: / Request Time:
Processed Date: / Processed Time:
Provider Name / English
Maltese
Site URL / English
Maltese
Functionality / Electronic Bill Presentment and Payment / HPP
Accounts / ON / OFF
Provider Controlled Recurring Payments / ON
OFF / OFF
Payment on account / ON
OFF / OFF
Status / ON / ON
Accept Payments across this Provider Accounts / ON
OFF / OFF
Payments / ON / ON
Allow payments for multiple invoices / ON
OFF / OFF
Automatic Subscriptions upon user first login / ON
OFF / OFF
Foreign Link to Provider on journal Entries / ON
OFF / OFF
Display Email in Payment Screen / ON
OFF
Custom skin for payment page / OFF / OFF
ON
New Skin (CSS)
Use same Skin from Test Environment ______
Web Service Details below are not to be provided for services running on the eForms and eProcurement platforms.
Web Service Url
url of where the Notifications webservice will be hosted
Web Service Username
Authentication to access Notifications webservice
Web Service Password
Authentication to access Notifications webservice(only the second half of the password is to be provided in this form. The first half is to be communicated to MITA eGov team via telephone)
Electronic Bill Presentment and Payment / HPP
Custom Field (if any) / Number / 1
Validation pattern / Not Applicable
English Name / Not Applicable
English Short Description / Not Applicable
English Long Description / Not Applicable
Maltese Name / Not Applicable
Maltese Short Description / Not Applicable
Maltese Long Description / Not Applicable
Not Applicable
Number / 2
Validation pattern / Not Applicable
English Name / Not Applicable
English Short Description / Not Applicable
English Long Description / Not Applicable
Maltese Name / Not Applicable
Maltese Short Description / Not Applicable
Maltese Long Description / Not Applicable
Not Applicable
Number / 3
Validation pattern / Not Applicable
English Name / Not Applicable
English Short Description / Not Applicable
English Long Description / Not Applicable
Maltese Name / Not Applicable
Maltese Short Description / Not Applicable
Maltese Long Description / Not Applicable
Not Applicable
Number / 4
Validation pattern / Not Applicable
English Name / Not Applicable
English Short Description / Not Applicable
English Long Description / Not Applicable
Maltese Name / Not Applicable
Maltese Short Description / Not Applicable
Maltese Long Description / Not Applicable
Not Applicable
Number / 5
Validation pattern / Not Applicable
English Name / Not Applicable
English Short Description / Not Applicable
English Long Description / Not Applicable
Maltese Name / Not Applicable
Maltese Short Description / Not Applicable
Maltese Long Description / Not Applicable
Supplementary Provider Information
Electronic Bill Presentment and Payment / HPP
Corporate Information (English and Maltese Versions) / (Required)
Soft Copy Provided / NotApplicable
Contact Details (English and Maltese Versions) / (Required)
Soft Copy Provided / Not Applicable
Terms and Conditions (English and Maltese Versions) / (Required)
Soft Copy Provided / (Required)
Soft Copy Provided
Provider Logo (English and Maltese Versions) / (Required)
Soft Copy Provided / Not Applicable

Provider Account Details

Please tick the Institution/s being used and list the Account Number and Terminal ID for each institution.
Bank Institution / Account Number / Terminal ID
BOV HSBC
BOV HSBC
BOV HSBC
BOV HSBC
BOV HSBC
BOV HSBC

CARD DETAILS

Please tick the Card Types accepted by this Client and fill in relevant information, where applicable.
CARD / ADDITIONAL INFORMATION
VISA
MASTERCARD
CASHLINK
QUIKCASH
APS PREMIER

Payment Gateway Reporting Portal Access

As part of the Payment Gateway service MITA provides access to a Reporting Portal. Through this portal you have the facility to issue various reports for reconciliation and verify the status of respective electronic transactions processed through the Payment Gateway.
Details of users (max. 3) to be granted access to this reporting portal are to be provided below. Due to the financial nature of the reporting portal it is recommended that one of the users be from the accounts section of your department.

User 1

I.D. Card Number : / Surname :
Phone Number : / Name :
e-mail address:

User 2

I.D. Card Number : / Surname :
Phone Number : / Name :
e-mail address:
User 3
I.D. Card Number : / Surname :
Phone Number : / Name :
e-mail address:

Contact Details

Government Department/Entity
Surname: / Phone Number (Fixed):
Name: / Phone Number (Mobile):
e-mail address:
Supplier
Surname: / Phone Number (Fixed):
Name: / Phone Number (Mobile):
e-mail address:

myBills Configuration Details (Office Use Only)

Business Group: / Transactium Client ID:
Business Unit: / Transactium Cashpoint ID:
MITAMerchant: / MITAMerchant ID:

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