Please fill the form appropriately for speedy funding


NOTE: e-Currency gateways like AlerttPay, Liberty Reserve, PayPal, etc do charge the Receiver of funds some percentage on the funds sent. For example, Liberty Reserve do charge 1% (if it's less than $300) or $2.99 (if it's $300 and above) of the amount you received from exchangers and senders.


If you have paid for Virtual Credit Cards, please click HERE to notify us with a different form.


Despositor's Name on Teller *
Address *
City *
State *
Product Paid For *
Date of Payment *
Mode of Payment *
Bank Branch
Teller / Batch Number *
Phone Number (Etisalat, Glo, MTN & Zain only) *
Email Address *
Amount Paid in Naira / Dollars *
LR Account Name
LR Account Number
PayPal Email (For Funding)
AlerttPay Email (For Funding)
Other e-Currency Account (For Funding)
Amount Ordered *
Additional Comment (If Any)
How did you hear about us?
Returning Customer? *