Register to Affiliate Portal

It takes less than 5 minutes to fill out our form so that we can learn more about you.

All information provided must be true if found false, your application will be rejected.

Company

First Name*

Last Name*

User Email*

Password*

Birthday/ Anniversary Date

Mobile*

Street Address1*

Street Address2

State / Province

City*

Country*

Postcode / Zip*

Instant Message*

Instant Message ID*

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Payment Information

Payment made to?

Payment Method

Payment Details

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Additional Questions

1. How long have you been into Affiliate Marketing?*

2. Which other Network(s) do you work with? Provide Email/Skype ID of your AMs in these Networks*

3. What is your traffic source?*

4. Please provide links to your personal Social Media Profiles*

5. Are you looking for any particular offer(s)?*

6. Website URL

7. Who referred you?*

8. How did you hear about Bloomclicks?*

9. We maintain a zero-tolerance for identity fraud. As such, please agree to the following: I agree that all information I have provided regarding my identity, address, country of residence, business name (if applicable) is accurate, truthful and valid.

Agree

10. I understand that providing false identity information will result in the immediate loss of my account

Agree

Register to Affiliate Portal

Payment Information

Additional Questions

COMPANY

WORK WITH US

ACADEMY

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