Quebmex Premium Membership Form

HTML

PREMIUM QUEBMEX membership form

Please complete this form after payment to gain access to the cashback program on future orders

Select *

NAME *

BUSINESS NAME

Email *

Contact Phone *

LOCATION *

BANK TRANSFER AMOUNT *

Select *

Would you like to add a comment or clarification?

ACKNOWLEDGEMENT AND ACCEPTANCE *✅ I accept the privacy policy and terms and conditions of the QUEBMEX CASHBACK program. I understand that the credit will only be valid for future orders and only if my PREMIUM membership is active. CASHBACK PROGRAM is valid for 12 months on a yearly basis and can be renew yearly. I accept that in the event of a refund request will be prorrated to next consecutive month and, if any banking transfer fees or processing of the amount and time depending on the financial institution will be accepted.I Agree

Upload a file or proof of paymentYou can upload your proof of payment if you would like to do so, it isn't compulsory

No file chosen

PREMIUM QUEBMEX membership form

Please complete this form after payment to gain access to the cashback program on future orders

Siguenos