Prepaid Credit Card Request Form

Apply below for a Prepaid Credit Card - Guaranteed acceptance with no credit checks - The card is issued within 7-10 days of placing your order and can be reloaded by cash payment or by standing order from a UK bank account or transfer from any bank account - Load your card with up to £5000 allowing you to purchase products that a low credit limit adverse credit card would not allow - Use your card online, over the phone, at grocery stores, petrol stations, chemists, ATM machines and 24 million merchants worldwide - No interest and no late payment charges to worry about - Funds loaded onto your card are available to spend within 3 business days.

Our Guaranteed Arrangement Fee £109

A further payment of a minimum of £10 will be necessary to activate the card - this is payable once you have received the card and you wish to load for the first time.

   
Personal Details
Gender
Title
First Name
Middle Name
Surname
Date of Birth (DD/MM/YYYY)
Address
Time At Above Address (YY/MM)
Contact telephone number(s):
Contact E-Mail:
   
Do you have a passport? No UK Non UK
Do you have a UK driving licence?
   
Payment Method
 

Cardholder Details (if applicable)

   
Title
Surname
Forenames
Address
Post Code
  
Email Address
Card Number
Card Valid Date (MM/YY)
Card Expiry Date
Issue Number
Security Number

Please supply any additional information here:

I acknowledge that I have read and agree to theTerms & Conditions of Business of Credit Medic




Prepaid Credit Card
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