Affiliate Registration

Login information

User name :
Password :
Confirm password :

Contact information

Email address :
First name :
Last name :
Address :
City :
State :
Country :
Zip :
Phone number :
Mobile number :

Payment information

Preferred payment method : Bank Transfer
Cheque
Money Booker
Other
PayPal
Bank account info
:
Cheque payable to
:
Cheque sending address
:
PayPal email address
:
Other payment info
:
V.A.T. :

Affiliate information

Website URL :
 
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