ORDER CARD

Registration Form

Name *

Email *

Phone *

Dropdown *

Address *

Marital Status

Work Status *

Company Name *

Work Position *

Contact Person *

Contact Person's Phone *

Passport or Curacao ID *

Copy of Public Service Receipt or other Document verifying your address *

What would you like to use your Melkar Prepaid Card for?

Please Confirm that you agree to our Terms & Conditions *

Complete this form and request your Melkar Prepaid Card. One of our agents will contact you and inform you about the state of your request.

NOTE: When completing this form and we have contacted you, you need to pass by in person to pickup your card.