Affiliate Sign Up - Big Win Affiliates

ACCOUNT LOGIN DETAILS

Username *

Required 4 characters.

Password *

Required 8 characters.

Confirm Password *

Required, equals Password.

ACCOUNT PROFILE DETAILS

First Name *

Email Address *

Company Contact Number

Website URL *

e.g: http://www.examplexyz.com

City *

Zip Code *

Skype ID

Required minimum 4 characters

Last Name *

Company Name

VAT Number

Company Number

Contact Number *

Address *

State/Province

Country *

PAYMENT DETAILS

Payment Settings *

Bank Account Details Paypal Details

First Name *

Last Name *

IBAN *

Account No. *

Bank Name *

Swift/BSB *

Address1 *

Address2

City *

State/Province *

Country *

BRAND

Brand

Website URL

Cozino

www.cozino.com

Wizard Slots

www.wizardslots.com

Mega Reel

www.megareel.com

Barbados Bingo

www.barbadosbingo.com

Slots Baby

www.slotsbaby.com

Slotzo

www.slotzo.com

666 Casino

www.666casino.com

Dream Jackpot

www.dreamjackpot.com

King Casino

www.kingcasino.com

Star Slots

www.starslots.com

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