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Account: Password:

PERSONAL INFORMATION

First Name: * Last Name: * Gender:

Male Female

Birth Date:

Address: * City: * Country: State / Province:
Zip / Postal Code: * Email: * Telephone: *

Password:

Re-Type Password: *

URL 1: URL 2: URL 3:

Business Types: Sportsbook, Casino, Racebook and Poker

* 25%-35% Net Revenue

If you would like to change your sportsbook commission structure, please contact affiliates@betus.com. Thank you.

How did you find out about us?

By submitting your registration information, you indicate that you agree to be bound by the terms and conditions of our Affiliate Service Agreement.

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	Payment by couriered check - UPS ($50 fee - min. payment $200)* (2-6 weeks waiting period depending on location) (Maximum of $10,000.00 – European and North American affiliates only)
	Payable to *:
	Physical Address of client *:
	Phone number for UPS delivery *:
	Set as default Payment Option

	Payment by MoneyGram -(limit of $2000 USD per client per day))* (Fee- $34.95 + 6% of payment amount Minimum Payment-$200)
	Payable To *:
	Address where funds will be picked up *:
	Phone number *:
	Set as default Payment Option

	BANK WIRE ($50 fee - min. payment $500)*
	Beneficiary *:
	Bank Name *:
	Bank Address *:
	Institution Number *:
	Branch # *:
	Account *:
	Routing Number or Swift Code *:
	Address of client on file with the bank *:
	Set as default Payment Option

	NETeller (Non-Canadian /Non-US affiliates only)* ($0 Fee - Minimum Payment $25)
	Name on NETeller Account *:
	NETeller Account *:
	Email Address *:
	Set as default Payment Option

	Transfer funds to Sportsbook Account(Non- Canadian affiliates only) * ($0 Fee - Minimum Payment $25)
	Name on account:
	Sportsbook Account *:
	Set as default Payment Option

	Transfer funds to Poker Account(Non- Canadian affiliates only) * ($0 Fee - Minimum Payment $25)
	Name on account:
	Poker Account *:
	Set as default Payment Option