REGISTER FORM


PLEASE FILL OUT THIS FORM TO REGISTER FREE ON BETSHOP

USER NAME *		* At least 6 characters are required. Please use small letters and numbers only.
PASSWORD *
CONFIRM PASSWORD
First Personal Question		This question can be asked by our operators before to give out any information about your account. Please choose questions only you know the answer to such us "What is your mother's middle name?"
Answer
Second Personal Question
Answer

First Name		Please make sure that all details are correct before to submit, so that we will be able to activate your account straight away. YOU MUST BE OVER 18 TO BE A CLIENT.
Last Name
Address
Zip
City
Country
Date Of Birth
Phone Mobile
Phone
Fax
E-mail address (required)

How did you hear about BETSHOP ?
Newspaper	TV	Internet	Radio	Would you like to forward this information to a friend of yours as well? Fill here his e-mail
Shop	Friend	Other	please specify
Would like to be informed of any new product any spesial offer BETSHOP when available ? YES NO

DEPOSIT AMOUNT			Please insert the amount using numbers only. Do not use any dots or commas. Select way of payment and follow the instructions given.

WAY OF PAYMENT	credit card
NAME ON THE CARD
CREDIT CARD NUMBER
EXPIRED DATE

	bank transfer
	postal transfer
Please fill here all the details necessary to process the requested transaction (es. beneficiary's name, bank's name, account number, sort code, etc)

I authorise Betshop Ltd. to debit the given credit card for the amount specified.
I understand that I need to provide to the company a photocopy of the used credit card (both sides) together with an identity card or passport copy before start using the betting account. The name on the credit card must be the one appearing on the identification document.

I hereby confirm that I have read, understood and agreed all the rules applied by Betshop

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