SegCard Application

Please be advised that in order to accept payments via Segcard, your webmaster, merchant or employer must be registered with Segpay.

Please fill out the following form. Do not forget to upload an image of your valid Government Issued ID or Passport as well as a Proof of Address dated within the last 90 days.

First Name *

Last Name *

Gender *

Birthday *

Email *

Phone Number *

Address 1*

Address 2

City *

State / County *

Postal Code *

Country *

Website URL *

Proof of Identity

Document Type *

Document Number *

Document Language *

Country *

Issue Date *

Expiry Date *

Front Side of Document *

Please upload a clear photo of your valid document dated within 3 months, and which clearly shows the 4 corners of the page.

Back Side of Document *

Proof of Address

Document Type *

Document Language *

Issued by *

Issue Date *

Front Side of Document *

Please upload a clear photo of your valid document dated within 3 months, and which clearly shows the 4 corners of the page.

Back Side of Document

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