Please provide your address as listed on your account
Please select your country
So that we can provide the best support, please choose the option/s that best fit with your situation
Please tell us the reason/s for your change in circumstances
You chose 'other' can you tell is in your own words why your circumstances have changed please
Tell us how long you expect you will help for (choose one from the drop down list)
How much can you pay us each time?
What is the Afterpay Order Number you need help with? You can find this on the order page when you log into your account
If you are a merchant - Please provide the Merchant ID - this can be found online within your Online Account. If you are a new merchant type NA.
If you agree, check box to continue.