PAL Program Registration | Chukka Caribbean Adventures

Name
First Last
Affiliate Username*
Affiliate Type*
Affiliate Email*
Name of Agency
Agency Type
IATA/CLIA Number:*
Phone #:*
Mobile #:
If not the same as Phone#.
Fax #:
How will you sell Chukka products and experiences? Please list your platforms here:*
(Example: website - www.yourwebsitehere.com, Instagram - @yourIG, Facebook - YourFacebookPageHere..etc)
Website
Password*
Enter Password Confirm Password

Strength indicator

Commission Method*
- Bank Transfer
- PayPal
Company Name
Beneficiary*
Account holder.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mailing Address (If different from above)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Bank Location*
- Jamaica or Barbados
- Other Country
GCT#
TRN#
Bank Account #*
Bank Name:*
Bank Account Type:*
Bank Branch:*
Branch Code:*
Intermediary Bank ABA Routing#:*
Intermediary Bank SWIFT Code:*
Beneficiary Bank:*
Beneficiary Bank Address:*
Beneficiary Bank SWIFT Code:*
Beneficiary’s Name:*
Beneficiary’s Address:*
Beneficiary’s Account #:*
Bank Account Currency:*
Barbados residents are only permitted to use BBD (Barbados dollar)
PayPal Email*
*
- I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify me for benefits.
*
- I have read and agreed to the AFFILIATE PROGRAM AGREEMENT, CHUKKA.COM Terms of Use & Privacy Policy.
Comments
This field is for validation purposes and should be left unchanged.