US Gambling Refund ™ Referral Affiliate Program Application Form

Looking to earn money on the side? Our gambling affiliate program is designed for individuals who organize casino bus trips, travel agencies, website owners (such as owners of gambling blogs and/or casino forums) and anyone else who can provide us with ongoing referrals of individuals who require tax help in reclaiming gambling taxes withheld by the IRS.

Due to the administrative duties and costs involved in running this gambling affiliate program, we cannot accept everyone that wishes to join. You must be able to demonstrate how you can generate successful referrals for us in order for us to accept your application. There is a minimum requirement of three successful referrals per year to stay in our gambling affiliate program.

Please complete the application form below to join our gambling affiliate program. The fields with an asterisk (*) are mandatory.

First Name*:
Last Name*:
Checks Payable To:
Email*:
Confirm Email*:
Company Name:
Telephone Daytime:
Telephone Evening:
Cell Phone:
Fax Number:
Street Number & Address*:
Apartment/Suite Number:
Town/City*:
Province/State*:
Postal Code/Zip Code*:
Country*:
Describe how you will be able to generate successful referrals for us*:
Number of referrals you think you can generate in a 12 month period*:
Website URL (if you plan to use your website to generate referrals):
Questions or Comments:
By clicking the “Partner with US Gambling Refund ™” button below, you accept the terms and conditions of our referral affiliate program agreement.