Affiliate Sign Up - 21LuckyBet

Username *

Required 4 characters.

Password *

Required 8 characters.

Confirm Password *

Required, equals Password.

First Name *

Email Address*

Company Phone Number

Website URL *

e.g: http://www.exampleabc.com

City *

Zip Code *

Teams ID

Required minimum 4 characters

Last Name *

Company Name

VAT Number

Company Number

Phone Number *

Address *

State/Province

Country *

Two Factor Authentication

Payment Settings *

Bank Transfer Neteller Details Skrill Details Crypto

First Name *

Last Name *

IBAN *

Account Number *

Bank Name *

Swift/BSB *

Address (line 1) *

Address (line 2)

City *

State/Province *

Country *

	Brand	Website URL
	21LuckyBet	https://www.21luckybet.com/
	Slots52	https://www.slots52.com/?a=5146
	Free Spirit Bingo	https://www.freespiritbingo.com/?a=5147
	BitBet24	bitbet24.com
	Citobet	https://citobet.com
	Betmonks	https://betmonks.phoenix365-prod.com/en

I accept the Terms and Conditions for 21LuckyBet.

[Note : Mandatory fields are marked with an asterisk (*)]