Reality Check - Electronic Payment Solutions

Please be sure to read our Affiliate Terms and Conditions.

Upon completion, you will be assigned an account number. We will be send the number to you via email upon approval. Your account number will be used to track the referrals sent from your website. If you have any questions please email us at info@reality-chk.com

Title:
First Name:
Last Name:
Company:
Website Address:
Email Address: *
Street Address:
Town:
County/State:
PostCode/Zip:
Country:
Phone (no dashes or spaces):
Fax (no dashes or spaces):

Choose Username/ Affiliate ID: * (Please create an ID your referrals can easily remember)
Choose Password: *
Confirm Password: *
Agent:
Terms & Conditions:	- I've read & agree to the Affiliate Terms & Conditions.

Reality Check Corp.
PO Box 300255
Midwest City , OK 73140
Ph. 405.210.3328. Toll Free 866.897.0947
Fax 866.881.6345

WebDesign: OklahomaWebDesign.com