Account Activation

Please complete the form below to create your TouchPay account. After submitting your information, you will receive an email which will include an activation link and a temporary password. Click on the link in the email to complete the account activation process.


* required field
First Name:*
Middle Name:
Last Name:*   Suffix:
Phone:*
Last 4 of SSN:*
Date of Birth:*
E-mail Address:*
Confirm E-mail Address:*  
Address:*
City:*
State:*
ZIP Code:* -
Verification Code: *
Type the characters you see in the picture below.

Letters are not case-sensitive.
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