Redemption Form

Already a GoPayment user and need a new/replacement reader? Complete the form below and we'll send one your way!

Business Name*

Use the business name you submitted in your merchant application.
Merchant Account Number*

Merchant Account Number is 16 digits

This 16-digit number is needed to confirm your account. Where do I find this?
Shipping Address:*

Use the address to which you would like the reader sent. Shipping to PO Boxes unavailable.
City:*
State:*
Zip*

First Name:*

Last Name:*
Contact information will be used to identify your account and contact you if more information is needed.