Contact Details

Please provide your personal contact information.

Full Name: * Email Address: * Home Phone Work Phone Cell Phone Address (Street): City: Zip: Country: * Messenger: ICQ UIN#: Skype:

Marketing Channel Information

Which of these marketing channels will you use to promote PoolAffiliates? Please select all that apply

Web
search Engine
Email Marketing
Offline Promotion

URL1: * URL2: URL3:

New Account Details

Username: * Password: * Referrer:

(if you have a referrer number or a name, please enter it here)

Rewards Models

Revenue Share: 20% - 30% from the Net rake
$20 - $40 CPA (per depositing player)
$1 - $2 CPL (per FREE fun registration).

Working in this model requires special authorization from Barosh Ltd.

How do we pay you?

Cheque
Wire
PayPal
Money Bookers

For each payment method, we'll need the following details:

Cheque: Mailing Address
Wire Transfer: Bank Address, Beneficiary name, Account no.,SWIFT/ABA /IBAN
PayPal: PayPal account
Money Bookers: Money Bookers account

Payment Details:

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