Publisher Sign Up

You are almost there! To get started, please fill in the following form as completely as possible. To find out whether your website qualifies to be a BannerConnect Publisher, please review our acceptance guidelines, and feel free to contact our publishing department with any questions or concerns. Whichever the outcome, you will always receive a personal reply to your application.

Personal Information

First Name: *

Last Name: *

Gender: *

Male

Female

Company Name:

Address: *

Postal code: *

City: *

Country: *

E-Mail Address: *

Phone Number:

Fax Number:

Billing Information

Payment Choice: *

PayPal

Wire Payment

Please choose your preferred form of pay out. In case of Wired Payments we do not pay out under $100,- (USD) monthly proceeds. You can also choose to go for both forms of pay out. In this case please let us know your preference in the comments field.

PayPal

PayPal Address:

If you prefer to be paid via PayPal then please fill in your PayPal E-Mail address

Wire Payment Details

Account holder name:

Account holder address:

Account holder country:

Account number or IBAN:

Your bank account number or IBAN (International Bank Account Number).

Routing / ABA / Fedwire:

Please provide the Routing / ABA / Fedwire details if available.

BIC / SWIFT code:

Bank Identifier Code or SWIFT Code.

Country bank:

Comments:

If you would like to add any comments regarding your sign up you can do so here.

How did you find us?: *

Acceptance Guidelines: *

I accept the Publisher Acceptance Guidelines.

Terms and Conditions: *

I accept the Terms and Conditions of BannerConnect.

Nederlands

E-mail:	publishers@bannerconnect.net
Phone:	+31 (0)46 7074992
Fax:	+31 (0)46 4517688

Publisher Sign Up

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