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  Application Form  
Please complete this form to register for your 12BET affiliate account.
Fields marked * must be completed


Contact Information

First Name *
Last Name *
Gender * Male Female
Email Address *
Verify Email Address *
Contact Number *
MSN *

Mailing Information

Address *
City *
Postcode/Zip *
Country *

Website Information

I have my own website
Website URL *    
I don’t have a website
Please describe how you would like to promote 12Bet if you don’t have the URL *

Preference

Language *
Security Question *
Your Answer *
Validation * Valiation Code

Payment Information

Payment Method
12BET Player Account
User Name *
Non-deposited account only

Affiliate Login
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Password:
Valiation Code
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