Payment Agreement Request

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Account Information

Are you the account owner *

Account Number *

Account First Name *

Account Last Name *

Country Code *

Account Phone Number *

Country Code *

Mobile Contact Number *

Email Address *

Confirm Email *

Product Type *

Documents

ID Type *

Account Owner's ID *

Files must be less than 4 MB.
Allowed file types: gif jpg jpeg png.

Additional Documents

Letter of authorization, power or attorney, tenancy agreement, etc.
Files must be less than 4 MB.
Allowed file types: pdf doc docx.

Authorized Contact's ID

Files must be less than 4 MB.
Allowed file types: gif jpg jpeg png.

Payment Terms

Outstanding Amount *

Initial Payment (1/3 of O/standing Bal) *

Reciept/MMG Reference # *

Number of Monthly Payments *

Payment Schedule

First Payment Date

Second Payment Date

Third Payment Date

Payment Terms *

I hereby understand and agree that in order for me to retain my GT&T service and before the approval of my payment request by GT&T, I shall make a payment equivalent to one-third of the sum due and owing to GT&T by me. Once such payment is made and subsequently my payment request is approved by GT&T, I hereby agree to make payments in the amount stipulated by me hereof in addition to the current monthly charges for my GT&T service on or before the 10th day of each month. Moreover, I understand and agree that failure to make the previously mentioned payments to GT&T on the stipulated dates will result in my GT&T service being disconnected forthwith and without any notice to me, at which time the entire outstanding amount shall become due and payable by me to GT&T.