Mudgee Money Sign Up Form

Please complete the following form and click the 'SUBMIT' button at the end. Please also attach a copy of your Eftpos Merchant & Terminal ID's and email to

Alternatively to access a hard copy form please click here. 

Address *
Main Contact Person
Main Contact Person
Select: Load Up & Redemption or Redemption Only
Please email a copy of your EFTPOS activation receipt/s to