Signup

If you wish to register as an affiliate, please fill out form provided for you below. The Payment Method drop-down menu lets you pick how you want to be paid for your traffic, and the Minimum Payout drop-down menu lets you pick the amount of payment you have to reach in order to be paid.

IndieBucks Affiliate Signup

Account Information
Username: Company:
Password: Verify Password:
URL:  
Preferences
Accept Mailings: Default Program:
Contact Information
E-mail: Verify E-mail:
ICQ: AIM:
Mailing Address
First Name: Last Name:
Address: Address (cont):
City: State:
Zip Code: Country:
Payment Details
Payment Method: Minimum Payout:
Bank Name: Bank Address:
Bank City: Bank State:
Bank Country: SWIFTCODE:
Routing Number US: Beneficiary Name:
Beneficiary Address: Beneficiary City:
Beneficiary State: Beneficiary Country:
Account Number: IBAN:
Memo to Bank: Extra Info:


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