Winbig21 - Create Affiliate Account

At Winbig21 we take pride in building and maintaining relationships with our affiliate partners. Please ensure that all your contact details are entered correctly so we can work together every step of the way.

Create Affiliate Account

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Company Information

Business Type
Company Name*		Owner Name

Website Information

Website Name		Website URL
Website Type		Website Category
Website Visitors

Personal Information

First Name*		Last Name*
Birthdate*
Username*		E-mail*
Password*		Security Question*
Confirm Password*		Answer*

Address Information

Address*		Address2
Country*		City*
Zip/Postal Code*		Province/State*
Work Phone*		Skype Address
Home Phone		Cell Phone
Fax

Payment Preferences

Payment Method*
Login Name*:
Casino*:
Account Number*:
Account Type*:
Bank Name*:
Bank Address*:
Bank Routing:
SWIFT:
IBAN:
Sort Code/BSB:
Extra Bank Info:

Reporting and Marketing

E-mail Subscription	Frequency	Subscribed
Commission Paid This will send an e-mail after your commission has been paid.	Transaction
Player Deposit This will notify you each time a new referral of yours places their first deposit..	Transaction
Weekly Signups Summary A weekly summary showing all your new referrals for the week.	Weekly
Revenue Summary A report summarizing all your affiliate revenue for the month.	Monthly

Winbig21 Newsletter	Monthly
Winbig21 Marketing News	Bi-Weekly
Winbig21 Casino News	Weekly

Terms & Conditions

Where did you hear about us?*

I have read and agree to the: Affiliate Program Terms & Conditions.*

Create Affiliate Account

E-mail Subscription

Frequency

Subscribed