Please complete the fields below so that we can create an account for you.

Personal Information

Full Name: *
Ex: Alex John
Prefix
Ex: Alex John
First *
Ex: Alex John
Last *
Ex: Alex John
Suffix
Ex: Alex John
Address: *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
NIC or Passport Number : *
Ex :6787676543V, N123456
Email: *
Confirm Email: *
Phone (Primary): *
MBSLanka Will send All Confirmations and Updates to This Number.
Phone (Alternative )

Services

Please Select Primary Service You need From MBSLanka
Services: *
 PayPal to Local Bank 
 MBSLanka's merchant 
 PayPal >< MoneyBookers 
 PayPal >< Alertpay 
 Web Hosting and Designing  
 MBSLanka's AFFILIATE 
If Merchant Service,
Your business website:
www.example.com
Business Category:
Ex: Travel&Tourism, Hosting etc ...

Account Information

Please Submit Your Banking and Account Informations for withdrawals.
Bank Name: *
Ex :HSBC Srilanka
Branch Name: *
Ex :Pettah Branch
Account Holder Name: *
Ex :Alex John
Account Number: *
Ex :8764565455
Account Type: *

Identity Information

Please attach scanned copy of you NIC or Passport. If you have more than 1 document Convert all files into one. ZIP or RAR

For Merchant Services please send followings:
Scanned colour copy of ID Proof
Scanned copy of Business registration
Acceptable Address Proof
Attach a File:
Maximum File Size Allowed : 2MB (2048KB)

Referral :
 Search Engines  
 Advertisement 
 News 
 MBSLanka's Current User (please submit His/Her Name) 

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 I Agree to the MBSLanka's Terms of service and Privacy Policy 
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