Referral Make

Now that you’re a member of the Program (you have joined, haven’t you?) you may make as many referrals as you like or ask us about our Master Agent Program if you more than 5 friends that want to join. Just use this form once for each referral.If you have any questions about this program, please contact us at [email protected]

Your Affiliate ID Number

Affiliate ID: *

Suggested Owner

Assign Referral to: *
(a specialized Contact Support Specialist)

Please provide us with the information about the friend you are Referring

First Name: *
Last Name:
Email Address: *
Daytime Phone: *
Secondary Phone:
Street Address or P.O. Box:
Suite or Apt:
City:
Zip or Postal Code:
State/Province/
Region:
Country:
Number of players: *
Timeframe:
Area of Interest:
Misc:
I have read and agreed to the terms and conditions of the
referral program.
* denotes required field
BOOKMAKING SOLUTIONS PRICE PER HEADIDS, the Pioneer in Price per Head Services and Solutions since 1997.