diff --git a/packages/offline-payment-integration/src/OfflinePaymentMethod.test.tsx b/packages/offline-payment-integration/src/OfflinePaymentMethod.test.tsx
index 90f47d004a..f2b26c487c 100644
--- a/packages/offline-payment-integration/src/OfflinePaymentMethod.test.tsx
+++ b/packages/offline-payment-integration/src/OfflinePaymentMethod.test.tsx
@@ -1,9 +1,10 @@
 import { createCheckoutService, createLanguageService } from '@bigcommerce/checkout-sdk';
 import { createOfflinePaymentStrategy } from '@bigcommerce/checkout-sdk/integrations/offline';
+import { Formik } from 'formik';
 import React from 'react';
 
 import { type PaymentMethodProps } from '@bigcommerce/checkout/payment-integration-api';
-import { render } from '@bigcommerce/checkout/test-utils';
+import { render, screen } from '@bigcommerce/checkout/test-utils';
 
 import OfflinePaymentMethod from './OfflinePaymentMethod';
 import { getMethod } from './payment-method.mock';
@@ -72,4 +73,48 @@ describe('OfflinePaymentMethod', () => {
 
         await expect(checkoutService.deinitializePayment).rejects.toThrow('test error');
     });
+
+    describe('formFieldsData', () => {
+        const formFieldsData = [
+            {
+                name: 'Purchase Order',
+                id: 'purchaseOrderNumber',
+                required: true,
+                type: 'number',
+                fieldType: 'text',
+            },
+        ];
+
+        it('returns null when formFieldsData is not present', () => {
+            const { container } = render(<OfflinePaymentMethod {...defaultProps} />);
+
+            expect(container).toBeEmptyDOMElement();
+        });
+
+        it('returns null when formFieldsData is an empty array', () => {
+            const props = {
+                ...defaultProps,
+                method: { ...defaultProps.method, initializationData: { formFieldsData: [] } },
+            };
+
+            const { container } = render(<OfflinePaymentMethod {...props} />);
+
+            expect(container).toBeEmptyDOMElement();
+        });
+
+        it('renders fields from formFieldsData via PaymentFormFields', () => {
+            const props = {
+                ...defaultProps,
+                method: { ...defaultProps.method, initializationData: { formFieldsData } },
+            };
+
+            render(
+                <Formik initialValues={{}} onSubmit={jest.fn()}>
+                    <OfflinePaymentMethod {...props} />
+                </Formik>,
+            );
+
+            expect(screen.getByLabelText('Purchase Order')).toBeInTheDocument();
+        });
+    });
 });
diff --git a/packages/offline-payment-integration/src/OfflinePaymentMethod.tsx b/packages/offline-payment-integration/src/OfflinePaymentMethod.tsx
index 30ebee589a..e2e6d3e28d 100644
--- a/packages/offline-payment-integration/src/OfflinePaymentMethod.tsx
+++ b/packages/offline-payment-integration/src/OfflinePaymentMethod.tsx
@@ -1,11 +1,14 @@
 import { createOfflinePaymentStrategy } from '@bigcommerce/checkout-sdk/integrations/offline';
-import { type FunctionComponent, useEffect } from 'react';
+import React, { type FunctionComponent, useEffect } from 'react';
 
 import {
+    getPaymentFormFields,
     type PaymentMethodProps,
     toResolvableComponent,
 } from '@bigcommerce/checkout/payment-integration-api';
 
+import PaymentFormFields from './PaymentFormFields';
+
 const OfflinePaymentMethod: FunctionComponent<PaymentMethodProps> = ({
     method,
     checkoutService,
@@ -46,7 +49,13 @@ const OfflinePaymentMethod: FunctionComponent<PaymentMethodProps> = ({
         };
     }, [checkoutService, method.gateway, method.id, onUnhandledError]);
 
-    return null;
+    const formFields = getPaymentFormFields(method.initializationData?.formFieldsData);
+
+    if (!formFields.length) {
+        return null;
+    }
+
+    return <PaymentFormFields fields={formFields} />;
 };
 
 export default toResolvableComponent(OfflinePaymentMethod, [
diff --git a/packages/offline-payment-integration/src/PaymentFormFields.test.tsx b/packages/offline-payment-integration/src/PaymentFormFields.test.tsx
new file mode 100644
index 0000000000..5b6b47efbd
--- /dev/null
+++ b/packages/offline-payment-integration/src/PaymentFormFields.test.tsx
@@ -0,0 +1,73 @@
+import { Formik } from 'formik';
+import React from 'react';
+
+import { type PaymentFormField } from '@bigcommerce/checkout/payment-integration-api';
+import { fireEvent, render, screen } from '@bigcommerce/checkout/test-utils';
+
+import PaymentFormFields from './PaymentFormFields';
+
+const fields: PaymentFormField[] = [
+    {
+        name: 'Purchase Order',
+        id: 'purchaseOrderNumber',
+        required: true,
+        type: 'number',
+        fieldType: 'text',
+    },
+    {
+        name: 'Reference',
+        id: 'referenceText',
+        required: false,
+        type: 'text',
+        fieldType: 'text',
+    },
+];
+
+const renderWithFormik = (ui: React.ReactElement) =>
+    render(
+        <Formik initialValues={{}} onSubmit={jest.fn()}>
+            {ui}
+        </Formik>,
+    );
+
+describe('PaymentFormFields', () => {
+    it('renders a label and input for each field', () => {
+        renderWithFormik(<PaymentFormFields fields={fields} />);
+
+        expect(screen.getByLabelText('Purchase Order')).toBeInTheDocument();
+        expect(screen.getByLabelText('Reference')).toBeInTheDocument();
+    });
+
+    it('uses numeric inputMode for number type fields', () => {
+        renderWithFormik(<PaymentFormFields fields={fields} />);
+
+        expect(screen.getByLabelText('Purchase Order')).toHaveAttribute('inputmode', 'numeric');
+        expect(screen.getByLabelText('Reference')).not.toHaveAttribute('inputmode');
+    });
+
+    it('strips non-digit characters from a number field on change', () => {
+        renderWithFormik(<PaymentFormFields fields={fields} />);
+
+        const input = screen.getByLabelText('Purchase Order');
+
+        fireEvent.change(input, { target: { value: '123abc' } });
+
+        expect((input as HTMLInputElement).value).toBe('123');
+    });
+
+    it('shows a validation error for a required field left empty', async () => {
+        renderWithFormik(<PaymentFormFields fields={fields} />);
+
+        fireEvent.blur(screen.getByLabelText('Purchase Order'));
+
+        expect(await screen.findByText('Purchase Order is required')).toBeInTheDocument();
+    });
+
+    it('does not show a validation error for an optional field left empty', () => {
+        renderWithFormik(<PaymentFormFields fields={fields} />);
+
+        fireEvent.blur(screen.getByLabelText('Reference'));
+
+        expect(screen.queryByText('Reference is required')).not.toBeInTheDocument();
+    });
+});
diff --git a/packages/offline-payment-integration/src/PaymentFormFields.tsx b/packages/offline-payment-integration/src/PaymentFormFields.tsx
new file mode 100644
index 0000000000..6f23208c07
--- /dev/null
+++ b/packages/offline-payment-integration/src/PaymentFormFields.tsx
@@ -0,0 +1,55 @@
+import React, { type FunctionComponent } from 'react';
+
+import {
+    getPaymentFormFields,
+    type PaymentFormField,
+} from '@bigcommerce/checkout/payment-integration-api';
+import { BasicFormField, TextInput } from '@bigcommerce/checkout/ui';
+
+export { getPaymentFormFields, type PaymentFormField };
+
+const validateField = (value: string, field: PaymentFormField): string | undefined => {
+    if (field.required && !value) {
+        return `${field.name} is required`;
+    }
+
+    if (field.type === 'number' && value && !/^\d+$/.test(value)) {
+        return `${field.name} must be a positive whole number`;
+    }
+};
+
+const PaymentFormFields: FunctionComponent<{ fields: PaymentFormField[] }> = ({ fields }) => (
+    <>
+        {fields.map((field) => (
+            <BasicFormField
+                key={field.id}
+                name={field.id}
+                render={({ field: fieldProps, meta }) => (
+                    <div style={{ paddingBottom: '1rem' }}>
+                        <label htmlFor={field.id}>{field.name}</label>
+                        <TextInput
+                            {...fieldProps}
+                            id={field.id}
+                            inputMode={field.type === 'number' ? 'numeric' : undefined}
+                            onChange={
+                                field.type === 'number'
+                                    ? (e) => {
+                                          e.target.value = e.target.value.replace(/\D/g, '');
+                                          fieldProps.onChange(e);
+                                      }
+                                    : fieldProps.onChange
+                            }
+                            type="text"
+                        />
+                        {meta.touched && meta.error ? (
+                            <p className="form-field-error-message">{meta.error}</p>
+                        ) : null}
+                    </div>
+                )}
+                validate={(value: string) => validateField(value, field)}
+            />
+        ))}
+    </>
+);
+
+export default PaymentFormFields;
diff --git a/packages/payment-integration-api/src/PaymentFormFields.test.tsx b/packages/payment-integration-api/src/PaymentFormFields.test.tsx
new file mode 100644
index 0000000000..0f6c32504a
--- /dev/null
+++ b/packages/payment-integration-api/src/PaymentFormFields.test.tsx
@@ -0,0 +1,29 @@
+import { getPaymentFormFields, type PaymentFormField } from './PaymentFormFields';
+
+const fields: PaymentFormField[] = [
+    {
+        name: 'Purchase Order',
+        id: 'purchaseOrderNumber',
+        required: true,
+        type: 'number',
+        fieldType: 'text',
+    },
+];
+
+describe('getPaymentFormFields', () => {
+    it('returns empty array when value is undefined', () => {
+        expect(getPaymentFormFields(undefined)).toEqual([]);
+    });
+
+    it('returns empty array when value is null', () => {
+        expect(getPaymentFormFields(null)).toEqual([]);
+    });
+
+    it('returns empty array when value is not an array', () => {
+        expect(getPaymentFormFields({ formFieldsData: [] })).toEqual([]);
+    });
+
+    it('returns the array when value is a valid array', () => {
+        expect(getPaymentFormFields(fields)).toEqual(fields);
+    });
+});
diff --git a/packages/payment-integration-api/src/PaymentFormFields.tsx b/packages/payment-integration-api/src/PaymentFormFields.tsx
new file mode 100644
index 0000000000..a54c5e259e
--- /dev/null
+++ b/packages/payment-integration-api/src/PaymentFormFields.tsx
@@ -0,0 +1,13 @@
+export interface PaymentFormField {
+    name: string;
+    id: string;
+    required: boolean;
+    type: string;
+    fieldType: string;
+}
+
+const isPaymentFormFieldArray = (value: unknown): value is PaymentFormField[] =>
+    Array.isArray(value);
+
+export const getPaymentFormFields = (formFieldsData: unknown): PaymentFormField[] =>
+    isPaymentFormFieldArray(formFieldsData) ? formFieldsData : [];
diff --git a/packages/payment-integration-api/src/index.ts b/packages/payment-integration-api/src/index.ts
index 6cd435ad36..4099046004 100644
--- a/packages/payment-integration-api/src/index.ts
+++ b/packages/payment-integration-api/src/index.ts
@@ -22,6 +22,7 @@ export {
 export { SpecificError } from './errors';
 export { getCountryData } from './CountryData';
 export { CaptureMessageComponent } from './CaptureMessageComponent';
+export { getPaymentFormFields, type PaymentFormField } from './PaymentFormFields';
 
 // export types separately
 export type { CountryData } from './CountryData';