Section 1 - Contact Details
Title
Mr
Mrs
Ms
Name
Country
Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia Herzegowina
Botswana
Bouvet Island
Brazil
Brit. Indian O. Terr.
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Rep.
Chad
Chile
China
Christmas Island
Cocos (Keeling) Isl.
Colombia
Comoros
Congo
Congo, D.R. Of
Cook Islands
Costa Rica
Cote D\'ivorie
Croatia (Hrvatska)
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
France, Metropolitan
French Guiana
French Polynesia
French Southern Terr.
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard McDonald Isl.
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Rep.
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, D.P.R. Of
Korea, Republic Of
Kuwait
Kyrgyzstan
Lao People Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamah.
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova, Rep. Of
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Isl.
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Kitts And Nevis
Saint Lucia
Saint Vincent & Gren.
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
Spain
Sri Lanka
St. Helena
St. Pierre & Miquelon
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, U. Rep. Of
Thailand
Togo
Tokelau
Tonga
Trinidad And Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Isl.
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
U.S. Minor Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands (British)
Virgin Islands (US)
Wallis And Futuna Isl.
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
E-mail
Phone
Mobile
How did you learn about RealTime Gaming?
Section 2 - Gaming Interest
Please check relevant boxes:
Casino
Mobile Casino Games
Land Based / Internet Cafés
Live Dealer
Section 3 - Business Background
Company Name:
Company Website(s):
Overview of current gaming business/venture plans:
Online gaming industry experience:
Target countries / markets:
From which jurisdiction do you (intend to) operate?
Do you have an online gambling license?
Yes
No
Are you currently processing financial transactions?
Yes
No
Expected capital commitment (include currency):
What is your target launch date?
Section 4 - Further Information
Please enter any other relevant details regarding your business strategy:
Preferred method of contact
Phone
E-mail
Verification Code
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Mandatory fields
