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  Application Form  
Please complete this form to register for your 12BET affiliate account.
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Contact Information

First Name *
Last Name *
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Email Address *
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Contact Number *

Mailing Information

Address *
City *
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Country *

Website Information

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Website URL *    
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Language *
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Your Answer *
Validation * Valiation Code

Payment Information

Payment Method
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User Name *
Non-deposited account only

Affiliate Login
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