EmailMe Form - Direct Deposit Verification

Retailer's Full Name: *
Registered Mobile No.: *
Enter your 12 digit retailer or registered mobile number using this format: 639201234567.
Payment Made On: *
For Loadwallet Deposit, please deposit to

UNIWIZ TRADE SALES, INC.

OTC= Over the counter
IBT= Internet Banking Transfer
Amount in Peso (PHP) *
[[js_currency_$ Pesos . Cents]]
Bank Branch: *
Bank Branch where you have deposited your loadwallet.
Put N/A if you transferred to Smartmoney.
Branch Code/Reference No.: *
BDO = 3 digits before the letter CD below the word UNIWIZ.
BPI = 3 digits on the upper right corner of the deposit slip
Enter the reference no. if SMARTMoney transfer has been made.
Date Time: *
MM / DD / YYYY HH : MM AM/PM
Enter the exact date and time found in your deposit slip or on the confirmation text if SMARTMoney transfer.
Valid Email Address: *
Enter valid email address to receive our reply.

Confirm Email Address:
Image Verification

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