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Notification Script Only Application
Please complete and submit the following form. If all the information submitted in the form below is accurate it will assist us greatly to expedite the exposure of your Ezybonds payment button on your website.
NOTE: The following details are used to integrate the Ezybonds payment button on your website. ALL details supplied are used solely for this purpose. This form is transmitted using secure encryption and the information securely retained.
You must have an established EzyAccount prior to registering for the Single (Quick) Button Solution.
Fields marked with * are mandatory.
Details about the product or service you are selling online - All values required
Product ID (Maximum 10 characters): *
The selling price of your product or service.
example: 12.95 (Minimum. $1.00):
 *
Brief product description (40 chars max.): *
Your EzyBonds login details:
EzyBonds MerchantID: *
EzyBonds Username: *
EzyBonds Password: *
5 digit security code: *
Your Contact Information
Organisation Name: *
Your Name: *
Telephone: *
Mobile:
Email address: *
State or Province: *
Country: *
Your technical person's contact details (if any)
Name:
Telephone:
Mobile:
Email address:
General Questions - optional
Do you require web hosting?
    - If not, what type of hosting are you currently using?
Do you plan to offer more than one product?