Finseta Affiliate Enrolment Form
Thank you for your interest in becoming a Finseta Affiliate. Please complete the form below.
Are you Individual or Business
*
Individual
Business
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Finseta Individual Affiliate
Full Name (Individuals / Sole Traders)
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Phone Number
Phone Number
E-mail
*
example@example.com
Website / Social Media (if applicable)
Company Name
Date of Birth (for Individuals / Sole Traders)
*
-
Day
-
Month
Year
Date
Residential Address (for Individuals / Sole Traders)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Bank Account Name (for Commission Payments)
*
Bank Name (for Commission Payments)
*
Account Number / IBAN (for Commission Payments)
*
Sort Code / SWIFT/BIC (for Commission Payments)
*
Have you Spoken to anyone from Finseta
*
Yes
No
How did you hear about Finseta Affiliate Program?
Who Did you speak to?
Please explain how you generate business that will be referred to Finseta
*
Please Upload the following Supporting Documents: Government Issued Identification, Proof of Address, Bank Statement
*
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Finseta Business Affiliate
Business Name
*
Business Incorporation Number
*
Country of Registration
*
Primary Contact Name (if business)
*
Registered Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Residential Address of Primary Contact
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website / Social Media (if applicable)
*
Email Address
*
example@example.com
Phone Number
*
-
Country Code
-
Area Code
Phone Number
Phone Number
VAT Number / Company Registration Number (if applicable)
*
Full Name (Primary Contact)
*
Business Bank Account Name (for Commission Payments)
*
Bank Name (for Commission Payments)
*
Account Number / IBAN (for Commission Payments)
*
Sort Code / SWIFT/BIC (for Commission Payments)
*
Please Enter your name
*
Please Tick the following box
*
I have permission to sign-up to Finseta on behalf of my business
Please explain how you generate business that will be referred to Finseta
*
What is your relationship to the business you are registering?
*
Have you Spoken to anyone from Finseta
*
Yes
No
How did you hear about Finseta Affiliate Program?
Who Did you speak to?
Please upload the following Supporting Documents Government Issued Identification, Proof of Address, Bank Statement
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Please Submit your form
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