Business Registration

a company from KIWI Agency

Complete this short form so we can start building your personalized DIVVI payment portal and get your practice ready to offer Smile Now, Pay Later.
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Let's start with your business information

This ensures we set up your business correctly. All this information should be completed by an executive, senior manager or someone who otherwise has significant responsibility for the control and management of your business.

Tell us about your business

This information is collected to better serve your business and comply with regulators and financial partners, as indicated in the Terms of Service.

Verify you represent this business

This account must be activated by an executive or by someone who has significant responsibility for the control and management of your business. If that's not you, someone else should complete this information.

Business owners

Due to regulatory guidelines, we're required to collect information on anyone who has significant ownership of your business.

Please add anyone who owns 25% or more of your business.

First Owner

Second Owner

Third Owner

Forth Owner

Public Information

This information may be visible in payment statements, invoices and receipts. The details should match what is displayed on your website or social media.

Bank Account for payouts

Earnings that you receive will be sent to this bank account

Form & Branding to set up payment page

Let us know which fields you would like the patient to complete when making a payment. These fields are usually helpful for identifying patients. Please also share your logo and branding colors so we can set up your payment page and form with your custom branding.

Confirmation & Submit

Please accept our terms and conditions to submit the information. Revise all the information submitted and incorrect information may create problems with your account.

Why We Ask for This Information

To properly create and integrate your payment system with Stripe and financing platforms (such as Klarna, Affirm, and Afterpay), it is necessary to collect specific business and ownership information.

Stripe and other payment providers require it for compliance

Payment processors are obligated by law (including KYC – Know Your Customer – and anti-money laundering regulations) to verify the legitimacy of businesses using their services.

To correctly register and verify your account

Providing accurate and complete information ensures a smooth onboarding process and prevents future account restrictions, delays, or potential holds on funds.

To securely deposit your payouts

The routing and account number are needed so that Stripe and the financing platforms can deposit your collected funds directly into your business bank account.

To avoid service interruptions

Incorrect or incomplete information can result in verification failures, delays in launching your payment page, or service suspension from payment providers.
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More questions?