General
1
Fields with an asterisk (
*
) are mandatory.
General
First Name
*
Field is required
Last Name
*
Field is required
Email
*
Field is required
Email Confirmation
*
Field is required
Phone Number
Company
Company/Individual/Website Name
*
Field is required
Website/Social Media
*
http(s)://
Field is required
Example Offer Landing Page / Product Page
*
http(s)://
Field is required
Address
Address 1
*
Field is required
Apartment, Suite, etc.
City
*
Field is required
Postal Code
*
Field is required
Country
*
Select Country...
Field is required
Additional Information
Referral Code
Bank Name
*
Field is required
Bank Country
*
Field is required
VAT Number (EU)
*
Field is required
Business Number
*
Field is required
Payment Terms (Net 15 or Net 30)
*
Field is required
Deal (CPA / RS / Baseline)
*
Field is required
CAP
*
Field is required
Negative Carryover Yes / No
*
Field is required
Does users need to wager bonus to trigger CPA?
*
Field is required
Click ID expiration when signed up
*
Field is required
Approved: Geo's we can run
*
Field is required
Casino license (MGA, CURACAO etc)
*
Field is required
Payment Provider (beneficiary name)
*
Field is required
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