Submit a Request

Need expanded access to restricted merchants? Let us know how we can help you

Name *

Login Email with Moon *

Account Type

Please specify the type of account for your merchant access request

Account Type *

Please select the merchant(s) you need unblocked

Please select the merchant(s) you need unblocked

Help us understand from what activities you receive funds to be used in Moon payments

Detail on Source of Funds *

Please specify the approximate monthly amount from each source (leave blank if none in any category)

Salary/Employment Income

Business/Self-Employment Income

Investment Income (dividends, interest, capital gains)

Rental Property Income

Retirement Income (pension, 401k, IRA, Social Security)

Inheritance or Gifts

Sale of Assets

Trust/Estate Distributions

Investor Capital Raised

Founder Contributed Capital (Bootstrapped)

Business Revenue

Investment Income (dividends, interest, capital gains)

Other sources

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We encountered an error while submitting your request. Please send your request to support@paywithmoon.com.