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Industry
Convenience Store
Gas Station Store
Wireless Mobile
Products
Prepaid Cards and Gift Cards
Mobile Dealer
Gaming Vouchers
Wireless
Meet the Team
Blog
Contact
Sign Up Now
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Join Now Prepay – Transition from Atlantic Prepaid
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Please enable JavaScript in your browser to complete this form.
Store Information
-
Step
1
of 3
Store Contact
Store Contact First Name
*
First Name
Store Contact Last Name
*
Last Name
Store Name (Doing business as)
*
Company Legal Name
*
(Exactly as it appears on your business license)
Store Phone Number
*
Store Email Address
*
Email
Confirm Email
notes Street Address
Store Address
Store Street Address
*
Address (Please include suite or unit number if required)
Store City
*
City
Store Province
*
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
Province
Store Postal Code
*
Postal Code
HST/GST Number
*
Do you have a PST/QST Number? (For applicants in BC, SK, MB & QC)
*
No
Yes
Please provide your PST/QST Number
*
Is there a Wi-Fi connection available at your store location?
*
Yes
No
By checking this box, I acknowledge and agree to the updated fee structure under the Now Prepay Program and understand that certain fees may be subject to change.
*
I acknowledge and agree to the updated fee structure under the Now Prepay Program
Next
Owner's Name
Owner First Name
*
First Name
Owner Last Name
*
Last Name
Owner's Mobile Phone Number
*
Owner's Email
*
Email
Confirm Email
(Please note that this email will be used to sign the retailer agreement through Adobe Sign)
Owner's Home Address (Please provide the owner's residential address)
Owner Street Address
*
Address Line
Owner City
*
City
Owner Province
*
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
Province
Owner Postal Code
*
Postal Code
Owner's Date of Birth
*
Next
Store Billing Address
*
Same as Store Address
Same as Owners Home Address
Different from Store & Home Address
Billing Address
Billing Street Address
*
Address Line
Billing City
*
City
Billing Province
*
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
Province
Billing Postal Code
*
Postal Code
Optional: Add Email Address for Billing:
Please confirm the date after which we can proceed with shipping, or the date you can receive shipments at your location. Once confirmed, we will arrange delivery to your store address.
*
Kindly note that if the shipment is refused or returned, non-refundable courier fees will apply.
Please provide any additional notes or information you'd like us to include as we set up your account.
Submit
