PRO MEMBER SIGNUP FORM


Thank you for making the decision to join Massive Leads . To continue, please complete the below form. Your account and affiliate web site will be automatically created.

You will only be able to access the paid member product area once your payment has been verified.

Your sponsor's (person who referred you) username is: rodin

  Pro Member  Signup Form
1) Enter ONE word for your username (all in lowercase eg. adexplosion )
2) Ensure that your email box is working and not full
3) Enter your password and write it down somewhere safe
Username:
Firstname:
Lastname:
Email:
Password:
Cellnumber:
City:
Province:
Country:

    Your method of payment

Please indicate which method of payment you used, or will be using to complete your R77 (incl VAT) membership payment.

IMPORTANT! Always be sure to quote your username (that's your one word unique login name) as a reference on all payments.

Payment Method:

Send your payment (R77) [be sure to quote your one-word USERNAME as a reference on all payments] to:

Postal:
Intraconnect cc
C/O Massive Leads
Po Box 1216
Benoni
Gauteng 1500
Tel: 083-495-1628
Fax: 086-5030-269

EFT Banking Details:
Bank: Nedbank
A/C Holder: Intraconnect cc
Branch Code: 190342 (some banks may use 8digits in that event use : 19034200)
A/C #: 1903 44 2001

If selecting Wizzit send to 083-4951628


     Your method of receiving commissions

Please indicate which method you prefer to use to receive your affiliate commissions. You can change this at any time.

Method:

If selecting Wizzit enter your Wizzit cellnumber:

I do agree to the terms and conditions as listed below (Tick)