Partners Program

Registration Form

1PERSONAL
2CONTACT
3PAYMENT
4ADDITIONAL

Username

Password

Re-Type Password

Please enter the text as it appears in the image above.

Select a security question

OR enter your own security question

Security Question Answer

Email Address

Re-enter Email

First Name

Last Name

Company Name

Contact Phone

Cell Phone

IM name

Skype Name

Address 1

City

State

Zip

Country

Website URL

Category

Target Market Detail

Preferred Language

Your Preferred contact method

How did you hear about us

Please provide here any information that can support your application and the compliance of your services.

During the past 5 years, have you and/or the Company been the subject of legal proceedings because of improper payments, bribes, misuse or misappropriation of public property, accounting fraud, or regulatory enforcement?

During the past 5 years, have you and/or the Company been the target of any lawsuits or investigations?

During the past 5 years, have you and/or the Company been the subject of, or an involved party, in Gambling Legal and/or Regulatory breaches?

During the past 5 years, have you and/or the Company been the subject of, or an involved party, in Advertising or Marketing breaches?

During the past 5 years, have you and/or the Company been the subject of, or an involved party, in personal data breaches, fines or enforcement?

Are you personally experiencing any gambling related harm, or suffer/have suffered in the past financially and/or psychologically as a result of gambling?

Are any of your Directors/Shareholders/Ultimate Beneficial Owners a Politically Exposed Persons (PEP)?

Have any of your clients been contacted by the Regulator or been fined as a result of activity conducted by your Company or the group companies?

I agree to opt into Midnite's network communications, announcements and newsletter. The subscriptions can be managed by logging into the Affiliate account.

Terms & Conditions and Privacy Policy
I confirm that I have read, accepted and agreed to Midnite's Affiliates Programme Agreement and Privacy Policy.