Merchant Registration Form

Register once to become a Celbux Merchant
*Required fields

a - z and _ : eg. kromdraai_farms, sallys_carwash

PHYSICAL ADDRESS
 

CONTACT DETAILS
(Account Administrator)

ALTERNATIVE CONTACT DETAILS
 

*Industry:


REQUIRED DOCUMENTATION:


We require documentation to process your registration. Please first select the type of applicant:

Applicant type:

AUTHORISATION:

I certify that the information in this Merchant Registration Form and in the supporting documents attached is true and complete. I understand that any false information will be grounds for rejection or termination of my Merchant Registration. By providing my information, I confirm that I have read and understood the annexed Celbux Merchant Terms and Conditions and Privacy Policy and that I agree to be bound thereto.