Glamour Bingo Form

Please fill all the fields below in order to be able to play and claim prizes:

First Name:		Last Name:
Country:		State:
City:		Zip Code:
Address:
Email:

Nickname:
Password:		Retype:

For all deposits applies the following bonus scheme:
20% Bonus for deposits between $20-$50
50% Bonus for deposits between $50-$200
75% Bonus for deposits between $200-$500
100% Bonus for deposits over $500

Only one account allowed per player
Each player should have a valid and unique email
Bonus Credits are playable but not redeemable
First are played cash credits, then Bonus Credits
Void where prohibited by law