Become a Merchant

You can use this form as the first step towards becoming a merchant, or to add a new site to your group.

Please complete all details below, * denotes a mandatory field. A member of the Merchant Support team will contact you to finalise your request.

Please complete all details, * denotes mandatory fields.

Date

25/04/2024

Type*

New Build

Take Over

New Build/Take Over Date*

Contact Name*

Email*

Company Name*

Site Name*

Site Street Address*

Site Suburb*

Site State*

Site Postcode*

Postal Address

Postal Suburb

Postal State

Postal Postcode

Phone Number*

Fax Number

Service Type*

Fuel

Non-Fuel

Merchant Type*

Motorpass

Motorcharge

Wright Express Terminal Required*

Yes

Please check the reCAPTCHA box below to proceed to the next stage in your application.

Merchant Name *

Existing Merchant Number *

Contact Name *

Email Id *

Company Name *

Site Name *

Site Street Address *

Site Suburb *

Site State *

Site Postcode *

Postal Address

Postal Suburb

Postal State

Postal Postcode

Phone Number

Fax Number

Service Type *

Fuel
Non-Fuel

Merchant Type *

WEX Motorpass
Motorcharge

WEX Terminal Required *

Yes
No

Become a Merchant

Merchant Enquiry Form.