Account CredenitalsRequest Form

If I have requested account credentials such as access to an account, please provide the relevant information below. This website is over SSL so your data is encrypted. Thanks.

Your Name

What are you providing?

Online Account Login Credentials

Just a password

Stripe integration API Keys

Email Credentials

Credit Card Information

Other

Name of Business or Service you are providing access to?

Website Address (URL) where I can login

Username

Password (see as you type option)

If you are in a secure place and want to see the password as you type it to make sure you enter it correctly.

Password (private mode option)

If you are NOT in a secure place then enter your password here and what you type will display as a series of dots to hide what you are typing.

Password (see as you type option)

If you are in a secure place and want to see the password as you type it to make sure you enter it correctly.

Password (private mode option)

If you are NOT in a secure place then enter your password here and what you type will display as a series of dots to hide what you are typing.

Stripe API Publishable key

Best to copy and paste into this field to get it correctly.

Stripe API Secret key

Best to copy and paste into this field to get it correctly.

Other login credentials

Enter here

Where is your email hosted? (ie Google, Hotmail, etc.)

Email Address

Password (see as you type option)

If you are in a secure place and want to see the password as you type it to make sure you enter it correctly.

Password (private mode option)

If you are NOT in a secure place then enter your password here and what you type will display as a series of dots to hide what you are typing.

Type of Card

Visa

Master Card

Amex

Name on Card

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit Card #

Expiration Date

CVV Digits on back of card

Name

This field is for validation purposes and should be left unchanged.

Account CredenitalsRequest Form

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