Contact and Social

Payment Express Sign Up Form

Payment Express Sign Up Form

    Application Form for New Merchant

    Please complete all of the required fields in this online application form. If you require assistance, feel free to contact us via our contact page.

    Company Information




    Physical Address


    Postal Address

    Same as Physical Address



    Management Contact






    Payment Information


    Terms and Conditions

    Terms and Conditions can be found here

    I agree to the terms and conditions

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