Activate a card Complete the following form. We will contact you. Card Type (required) ---VISAMaster Card 16 digits number (required) Card holder name (required) Your Email (required) Select Country(country code will be auto generated) ---AfghanistanAlbaniaAlgeriaAmericanSamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBosnia and HerzegovinaBotswanaBrazilBritish Indian Ocean TerritoryBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLatviaLebanonLesothoLiberiaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMonacoMongoliaMontenegroMontserratMoroccoMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRwandaSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSouth AfricaSouth Georgia and the South Sandwich IslandsSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandTajikistanThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuWallis and FutunaYemenZambiaZimbabweland IslandsAntarcticaBolivia, Plurinational State ofBrunei DarussalamCocos (Keeling) IslandsCongo, The Democratic Republic of theCote d'IvoireFalkland Islands (Malvinas)GuernseyHoly See (Vatican City State)Hong KongIran, Islamic Republic ofIsle of ManJerseyKorea, Democratic People's Republic ofKorea, Republic ofLao People's Democratic RepublicLibyan Arab JamahiriyaMacaoMacedonia, The Former Yugoslav Republic ofMicronesia, Federated States ofMoldova, Republic ofMozambiquePalestinian Territory, OccupiedPitcairnRéunionRussiaSaint BarthélemySaint Helena, Ascension and Tristan Da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSao Tome and PrincipeSomaliaSvalbard and Jan MayenSyrian Arab RepublicTaiwan, Province of ChinaTanzania, United Republic ofTimor-LesteVenezuela, Bolivarian Republic ofViet NamVirgin Islands, BritishVirgin Islands, U.S. Phone Code Phone Number Upload Passport or ID card - both sides, and Proof of Address Document Type (required) ---PassportID Card Photo of the passport Frontside and backside photo of the ID Card Privacy Policy This form collects your cardholder's name or the card activation number, email, and phone number. We need this information to be able to activate your card. Please read our Privacy Policy to discover how we protect and manage your submitted data. The internet is not a secure place, however, we have gone to great steps in making sure the information you submit to us is as secure as possible. We use SSL (Secure Socket Layer) certificates to encrypt the communication between your computer and our web server. If you are not completely happy to provide information via the internet please contact the practice directly. I consent to the conditions.