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Retailer Application Form
This is LoadCentral's official application form.

Notes: Your account registration will be processed within one (1) to three (3) working days. Upon registration, you will receive an SMS and e-mail sent to your provided contact details. Please ensure that all your contact details are CORRECT to avoid non-receipt of notifications.

Please note that LoadCentral's operating hours (Sales and Marketing) are from 9AM to 6PM Mondays to Fridays, except holidays.

Complete Name
Your answer
Business Name
N/A if none
Your answer
Complete Address
Please input your complete address.
Your answer
E-mail address
Should be active. LoadCentral representative will contact you thru this e-mail address.
Your answer
Contact Number
Should be active. LoadCentral representative will contact you thru this mobile number.
Your answer
Mobile Number to register
Account can be accessed thru internet and your mobile phone.
Your answer
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