PERSONAL INFORMATION

First Name: *
Last Name: *
Gender:
Birth Date:
Password:
*
Re-Type Password: *

CONTACT DETAILS


Address: *
City: *
Country:
State / Province:
Zip / Postal Code: *
Email: *
Telephone: *

PRIMARY WEBSITES

URL 1:
URL 2:
URL 3:

OTHER INFORMATION

By submitting your registration information, you indicate that you agree to be bound by the terms and conditions of our Affiliate Service Agreement.

 

PAYMENT OPTIONS

Payee Name:   

Payment by couriered check - UPS ($50 fee - min. payment $200)*
(2-6 weeks waiting period depending on location)
(Maximum of $10,000.00 – European and North American affiliates only)
Payable to:
Physical Address of client:
Phone number for UPS delivery:
Set as default Payment Option
Payment by MoneyGram -(limit of $2000 USD per client per day))*
(Fee- $34.95 + 6% of payment amount Minimum Payment-$200)
Payable To:
Address where funds will be picked up:
Phone number:
Set as default Payment Option
BANK WIRE ($50 fee - min. payment $500)*
Beneficiary *:
Bank Name *:
Bank Address *:
Institution Number *:
Branch # *:
Account *:
Routing Number or Swift Code *:
Address of client on file with the bank *:
Set as default Payment Option
NETeller (Non-Canadian /Non-US affiliates only)*
($0 Fee - Minimum Payment $25)
Name on NETeller Account *:
NETeller Account *:
Email Address *:
Set as default Payment Option
Transfer funds to Sportsbook Account(Non- Canadian affiliates only) *
($0 Fee - Minimum Payment $25)
Name on account:
Sportsbook Account *:
Set as default Payment Option
Transfer funds to Poker Account(Non- Canadian affiliates only) *
($0 Fee - Minimum Payment $25)
Name on account:
Poker Account *:
Set as default Payment Option