Affiliate Signup Form

Affiliate Signup Form
Contact*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Commission Payment
Commission payments are made monthly to your bank account. You don't need to have a business account, a standard Paypal account is acceptable.
bank name*
eg Ecobank (oceanic formally)
Act. Name*
John Smith Pedro
Act. Number*
0060959371
passport photograph*

Upload a File

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