Affiliate Application


Affiliate Details

Full Company Name / Individual: *
Trading Name(s) if different:
Address1: *
Address2:
Town: *
County:
Country: *
Postcode: *

Contact Details

Forename(s): *
Surname: *
Job Title:
Email Address: *
Daytime Telephone: *
Mobile Telephone:
Fax:

Commission Payment Details

Beneficiary Account Name: *
Name of Bank: *
Bank Address: *
Account/IBAN Number: *
Sort Code: *
Swift/BIC/ABA:
Currency of Payments: *
Any Payment Reference Details:

Declaration

"If entering this agreement on behalf of a company or legal entity I can confirm that I am a duly authorised representative of the entity named above"

I have read and agree to the TorFX Affiliate Terms and Conditions
and the TorFX Affiliate Content Terms
Name: *
Date (dd/mm/yyyy): *
Position:
(required if you are signing on behalf of a company)

* required fields