Paymax - Registration

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* Denotes a required field

1a. Contact Details

Title *

First Name *

Last Name *

Please provde us with your official name i.e. the name you use on your passport.

Passport First Name *

Passport Last Name *

Address ! *

Town ! *

County !

Post Code *

Home Phone

Mobile Phone *

Email Address *

Confirm Email Address *

Additional Email Address For Contract

Email Notification Yes No

SMS Notification Yes No

Registering Registering on behalf of someone else?

2a. Personal & Banking Details

Gender Male Female

Date of Birth

EU National? Yes No

Country of Origin

National Insurance No

Tax Code Status

This is my first job since last 6 April and I have not been receiving taxable Jobseeker's Allowance or taxable Incapacity Benefit or a state or occupational pension
This is now my only job, but since last 6 April I have had another job, or have received taxable Jobseeker's Allowance or Incapacity Benefit. I do not receive a state or occupational pension.
I have another job or receive a state or occupational pension.

Agency Name *

Job Title *

Start Date

Bank Name *

Account Name *

Account Number *

Sort Code *

Roll Ref

3rd Party Account Yes No

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Register with Paymax



By ticking this box you agree that you have read the terms and conditions offered by set out above and you confirm your acceptance of these terms and that you intend to be legally bound by them.

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Please conplete the form above, once complete you will be able to continue with the application.

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Register with Paymax

Step 1

Contact Details

Step 2

Personal & Banking Details

Step 3

Upload Documents

Step 4

Application Complete