Payment Submit

[page_header title=”Payment Receipt Submission”]

[row]

[col span__sm=”12″]

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Email *

Phone *

Payment Bank *

• Sampath Bank
• Commercial Bank
• Bank of Ceylon
• NTB Bank

Order ID *

Upload your Payment Receipt *

Click or drag a file to this area to upload.

Additional Information

Submit

[/col]

[/row]