Name
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Email
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Phone Number
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Clear Picture of Drivers License: Front
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Clear Picture of Drivers License: Back
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Clear Picture of Medicare Card
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Clear Selfie (So We Can Verify It's Really You)
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Recent Bank Statement (To Verify Your Address)
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What bookie accounts are you registered with? (Select all that apply)
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Do you already have an UP account?
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Additional information
Terms & Conditions
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By ticking this box, I agree to the Terms & Conditions of Loyalty Punting, consent to the use of wagering accounts to Loyalty Punting, and acknowledge that this account may or may not be used, and deleted upon resolution of all activities.
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