First Web Online Casino Affiliate Request Form

Affiliate Information Request Form

Interested in becoming an affiliate for First Web Casino?

First Web Casino is a member of the BrightShare affiliate network, the program of choice for the Internet's most respected casino affiliates. By working exclusively with reputable, high-quality casinos, BrightShare delivers high per-player revenue and up to 35% commission. For more details on our affiliate program, and to find out how to join, please fill out the form below:

Your Contact Details

First Name:

Last Name:

Email:

Phone Number:

Mailing Address:

Street Name and Number:

State:

Zip Code:

Country:

Date of birth:

Your Websites

Website URLs:

Your Position:

Payment Details

Note: Commissions are paid monthly via PayPal (for payments between $100 to $1,500) or bank wire (for payments of $1,000 or more).

PayPal account number:

Bank Wire Details:

Account Name:

Account Number:

Bank Name:

Bank Address:

Swift/ABA Code:

A Few Questions...

1. Are you a member of any other casino affiliate program?

No Yes

2. Does your website advertise pornographic or other adult content?

No Yes

3. How many unique visitors does your site average per month?

4. Do you have casino reviews posted on your site?

No Yes

5. If advertised offers change, could your site commit to updating affiliate content within 5 working days?

No Yes

6. Are you interested in receiving html mailers?

No Yes

7. Which geographic region does your affiliate program target? Geographic region:

8. Is there anything else you would like us to know?

9. Please check the brands that you wish to become affiliated with:

	All Slots Casino		Wild Jack Casino
	First Web Casino		All Jackpots Casino

I have read and accept BrightShare's terms and conditions.

Enter the code as it is shown in the box below. (case sensitive)

Our Commitment

We appreciate your interest in joining our affiliate program, and the time you've taken to fill out this form. We guarantee that every submission will be reviewed and responded to as quickly as possible by one of our dedicated affiliate managers.

By Submitting this form, you agree to the Terms & Conditions of the BrightShare affiliate network.