Qualtrics Survey | Qualtrics Experience Management

Thank you for expressing interest in MoneyGram Access. Please complete this expression of interest form to request an application for the MoneyGram Access Program.

Note that all information provided will be kept in strict confidentiality with MoneyGram.

Please provide the following information to request an application for the MoneyGram Access Program.

RequiredBusiness Legal Name / DBA / Previous Business Names:
RequiredAddress
Address 2
RequiredCity/Town
RequiredState/Province
RequiredZip/Postal Code
RequiredCountry
RequiredWebsite:

Primary Contact

Required

Name
Email Address
Phone Number

Monthly Active Users

Required

0 (We are a start up and launching our product)

<10,000

10,000 - 50,000

50,000 - 100,000

100,000 - 500,000

500,000 - 1 million

1 million+

Are you a custodial or non-custodial wallet?

Required

Custodial

Non-Custodial

We are a remittance provider and have not integrated crypto products/services

Please select which of the following programs you currently have:

Required

KYC/AML Program

Sanctions Screening Program/Vendor

Blockchain Monitoring Program/Vendor

selecting this may deselect othersNone of these

Please specify which countries in Africa you operate in. Enter n/a if you do not operate in this region.

Required

Please specify which countries in Asia you operate in. Enter n/a if you do not operate in this region.

Required

Please specify which countries in Europe you operate in. Enter n/a if you do not operate in this region.

Required

Please specify which countries in Latin America you operate in. Enter n/a if you do not operate in this region.

Required

Please specify which countries in the Middle East you operate in. Enter n/a if you do not operate in this region.

Required

Please specify which countries in North America you operate in. Enter n/a if you do not operate in this region.

Required

What do you hope to gain from a MoneyGram integration?

Required

Please feel free to include any attachments providing more information about your company.

or drag here

Please use this space to provide any additional information you would like to share.