Ordering form - شركة نيوكاش لخدمات الدفع

Enter your data to fill out the package request.. We will contact you as soon as possible

Store Name *

Full name in English *

Full name in Arabic *

Mother's name in English *

Mobile number *

e-mail *

Identity number *

Identity type *

Gender

Date of birth *

Place of birth

Nationality *

City *

Adress *

Area *

الحي *

Business type *

هل أنت معرض سياسياّ ؟ *

Are you the real beneficiary of the account? *

اسم المعرض سياسياً الرباعي (عربي) *

اسم المعرض سياسياً الرباعي (انجليزي) *

ًصلة القرابة مع المعرض سياسيا *

المنصب للمعرض سياسياً *

اسم المستفيد الحقيقي و طبيعة العلاقة *

Store Owners Identity *

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Valid license *

No file chosen

Picture of the store (inside and outside) *

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NeoCash Private Joint Stock Payment Services Company is registered with the Companies Registrar at the Palestinian Ministry of National Economy under number (562523068).

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