PLATINUM BUCKS - Video Store SignUp

We shall begin with a few questions regarding your site and login information once your account with Platinum Bucks has been approved. Please be accurate in your entries and check all URLs submitted, the information you enter here will reflect part of your store configuration which is critical to a quick and easy installation.
Your adult site address:
Now we need a directory in your domain where you will install the store, the default directory name is 'videostore'. If this name is inconvenient for you just change the default name to something else, no slashes are required in the name. Enter the name of your store directory name:
Directory:
Next we need a username and password to setup your merchant account, it is imperative that you record this information since this is what you will be using to access sales statistics and options for your store. Maximum legnth is 12 characters for both, all of which must be upper or lower case characters or numbers. Do not use any special characters.
Username:
Password:
Retype Password:
Payment Information:
Checks Payable To:
Mailing Address:
Address:
City:
State:
Country:
Zip/Postal Code:
Phone:
Fax:
Site Name:
SSN/Tax Id ( NA if Not Applicable ):
Contact Information (Link code will be sent to you):
Contact Name:
Email:
ICQ:

Please only hit the "Create Account" button once.
Your account instructions and dialer will be emailed to within 24 Hrs.