Affiliate Program - Sign Up
Your personal dates
Gender:
Mr.Ms./Mrs.*
First Name  *
Sure Name:  *
Date of Birth:  * (e.g. 05/21/1970)
E-Mail Addresse:  *

Company dates
Compamy  ENTRY_AFFILIATE_COMPANY_TEXT
VAT-ID:  ENTRY_AFFILIATE_COMPANY_TAXID_TEXT

You get your money by:
Check Payee Name:  ENTRY_AFFILIATE_PAYMENT_CHECK_TEXT
PayPal Account eMail:  ENTRY_AFFILIATE_PAYMENT_PAYPAL_TEXT
Bank Name:  ENTRY_AFFILIATE_PAYMENT_BANK_NAME_TEXT
Bank Code:  ENTRY_AFFILIATE_PAYMENT_BANK_BRANCH_NUMBER_TEXT
SWIFT Code:  ENTRY_AFFILIATE_PAYMENT_BANK_SWIFT_CODE_TEXT
Account Holder:  ENTRY_AFFILIATE_PAYMENT_BANK_ACCOUNT_NAME_TEXT
Account No.:  ENTRY_AFFILIATE_PAYMENT_BANK_ACCOUNT_NUMBER_TEXT

Your postal address
Street/No.:  *
Suburb:  
ZIP-Code:  *
City:  *
Country:  *

Your contact information
Phone Number:  *
Fax Number:  
Homepage:  ENTRY_AFFILIATE_HOMEPAGE_TEXT

Your password
Password:  *
Confirmation:  *

ENTRY_AFFILIATE_ACCEPT_AGB

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