Affiliate Program – Sign Up

Personal Information

Username (Email)

First Name Last Name Your referral ID The ID you wish to have in your affiliate links, e.g. https://domain.com/#myReferralID Parent affiliate The ID of an affiliate who has introduced you to this affiliate program.

Additional Information

Web URL Company name Street City County Postcode Phone

Payout methods

Payout methodMoneybookers PayPal Cheque Bank / Wire transfer

Moneybookers Email

PayPal Email

Payable to

Bank account name Bank account number Bank name Bank code Bank address Bank SWIFT code

Terms & conditions I agree to the terms & conditions