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Programma Affiliato

Se hai già un account AFFILIATO, effettua il login alla login page.

Per creare un account affiliato, compila il modulo sottostante assicurandoti di compilare tutti i campi obbligatori:

I tuoi dati

* Nome:
* Cognome:
* E-Mail:
* Telefono:
Fax:

Il tuo indirizzo

Azienda:
Sito Web:
* Indirizzo 1:
Indirizzo 2:
* Città:
* COdice Postale:
* Provincia:
* Stato:

Informazioni Pagamento

Tax ID:
Metodo di Pagamento:
Nome del beneficiario:
PayPal Email Account:
Nome Banca:
ABA/BSB number (Branch Number):
SWIFT Code:
Account Name:
Account Number:

Password

* Password:
* Conferma Password:
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