Flexipay Application Please enable JavaScript in your browser to complete this form.Request for QuotationID Number *First Name(s) *Surname *Contact Number *Email *Address *Reason for Applying for Flexipay *Debt Review did not work for meI need flexible payment reliefI need more cashflowConsolidate my instalmentsI do not want to be blacklistedI want my name clearedI hereby appoint and consent to Flexipay™ to request and receive from Compuscan my credit report in the same format as I would have received it had I requested in person. DC subscriber agreement v.1.1. from Compuscan information technologies. Flexipay will treat your information with the utmost confidentiality and will not share it with a third party.DateSignatureClear SignatureSubmit