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Please enter your 6-digit Numerical Payzone Store ID (e.g. 456789)

Retailer First Name

Retailer Surname

Please Enter Your Store Name

Store Address (including postcode)

Fascia*

Mobile

Telephone

Annual Turnover*

Store Type*

Select Your Store Size*

Do you have a strong 4G signal in store?*

Name of Payzone Refferer

Are you a Non-alcohol store?