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    Silver seller claim form

    Use to register your claim for referral reward payments


    (If you're not yet a registered SILVER SELLER read here first)

    Name *
    My affiliate code *
    The code allocated to you at commencement
    Email *
    Phone *
    Buyers name (where known)
    Items purchased
    A rough description is suitable
    Transaction dollar value *
    Must be the EXACT dollar value of the transaction
    COINSHOP internal transaction reference *
    The buyer will have an email with this data
    Banking details *
    The BSB and ACCT number for direct transfer