* marked fields are Compulsory.

Username & Password will be generated by admin and sent to you via e-mail while activation.

*Name:
*E-mail:
*Facebook ID:
Address:
*City:	State:
*Country:	*Postal Code (PIN/ ZIP):
Phone:	Mobile No:
*Date of Birth:	*Gender: SELECT Male Female
Profession:
Your Payment Receiving Information (Used for making payments to you only)
*Payee Name:
Your Bank Name:
Bank Branch:
IFSC Code:
Your Bank A/C No#
Your Bank A/C Type:
Package
*Package/Scheme:	Affiliate Registration.
Website Type:
Website Address (URL):
Website Age / Traffic:
Photo:	.jpg file, upto 500 kb.
ID Proof:	Scan, .jpg file, upto 500 kb.
Registered By:
Acceptance of Terms
By clicking the checkbox, I certify that I have read and agree to the UNIVERSAL INFO SERVICE, and to receive communications from UNIVERSAL INFO SERVICE.
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