Tuesday, July 24, 2012

AdsZens Pre-Registration Form

AdsZens Pre Registration Form

PERSONAL INFORMATION

First Name *
Middle Name *
Last name *
Birth Date *

Month 		/
Day 		/
Year
Gender *
Country *
Complete Address *
Important: This is your mailing address. Used for sending products.
Mobile Number *
Phone Number *
Email Address *
Must be a valid EMail address
Confirm Email *

MEMBERSHIP

AdsZens UserName *
Alpha numeric only (A-Z and 0 - 9). Use comma to separate multiple user names.
Alternative UserName *
Sponsor Name
Leave "Bert Quintana" on the field if you don't have sponsor.
Sponsor Username
Leave this field blank if you don't have sponsor.
Placement Username
Leave this field blank if you don't have sponsor.
Placement Position
Leave this field blank if you don't have sponsor.
Product Package *
For verfication, check the updated product package [click here]
Other Package
Fill-up this field only if you choose others on the Product Package field.

OTHERS

Facebook URL
Notes

FINALIZE

Please review the form to make sure that you have answered all fields correctly. Click the submit button if you're done.


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