virtual credit card payment notification form


NOTE: Use this form ONLY to notify us of your payment for Virtual Credit Card. We can ONLY register VISA card issued by our USA Bank with the names, address (including zip codes) and phone number given. That of VISA cards from Russian Bank can take any name, address and phone numbers provided you used the IP address of the country in your billing address.

Also, make sure you provide us the exact names, address (including zip codes) and phone number required to register your VCC - especially for PayPal account verification. If there are mistakes from you, we shall NOT be held responsible.

Despositor's Name on Teller /LR Account *
Address *
City *
State /Region *
Country *
Product Paid For *
Date of Payment *
Mode of Payment *
Bank Branch
Teller / Batch Number *
Phone Number *
Email Address *
Amount Paid in Naira / Dollars *
VCC Value Paid For *
VCC Bank Issuer
Info For VCC Registration (USA Cards ONLY)
How did you hear about us?
Returning Customer? *