1-888-254-4999 | services@greendot.ca
 

License Application Form

To apply for a license, please complete the license application form below. The application also requires completion of the Green Dot North America User Agreement that needs to be uploaded as part of the form submission.

    First Name*

    Title*

    Street Address*

    State/Province*

    Postal Code/Zip*

    Phone*

    Product Name & Brief Description*

    Purchase Order Number (if applicable)

    Upload PDF of Signed Agreement*

    Last Name*

    Company Name*

    City*

    Country*

    Primary Email Contact*

    Billing Email Contact*

    Fax

    Website*

    Questions/Comments

    Input this code: captcha

    Contact Information

    Green Dot North America™
    Local: 647-925-1149
    Toll-Free in North America:
    1-888-254-4999

    1 St. Clair Avenue West
    7th Floor
    Toronto, Ontario
    M4V 1K6
    services@greendot.ca