EuroVegas Partners

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The information is required for billing and administration purposes, and valid data will speed up cash out procedures.

ACCOUNT DETAILS

First name

Last name

Username

Password

Repeat password

Phone number

Mobile number

Fax number

Website URL

Company

VAT Number
(if applicable)

Occupation

Comments

Address

City

State

Zip code

Skype Name

Country

PAYMENT DETAILS

Payment Options

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Beneficiary name

Address

Country

VAT

Bank Name

IBAN

Account Number

SWIFT/BIC

Beneficiary name

Address

Country

VAT

Neteller Account ID

Beneficiary name

Address

Country

VAT

Email on Skrill Account

Beneficiary name

Address

Country

VAT

Account number

Beneficiary name

Address

Country

VAT

Email on PayPal Account

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