Registration for new users.
Clients Database::Registration Form
SUPERDEALER
Registration
Kindly fill-up all fields accurately. By registering, you confirm that all information you submit are truthful and valid.
User ID
Please enter your 10-digit LoadXtreme Dealer ID number. This will be your Login ID after registration.
Activation Code
Enter you 16-digit Activation Code.
Referrer ID
Please indicate the ID number of your Referrer (Sponsor).
Placement ID
Indicate the CORRECT Placement ID number where this registration will be placed under.
Team Placement (A or B)
[Select Points_team]
Team A
Team B
Please ensure proper Team Placement (A or B). This cannot be modified once submitted.
Last Name
First Name
Middle Name
Birthdate
Mobile Number
Email
Tax Identification Number (TIN)
Enter your Philippine Tax Identification Number (TIN) in the following format: 000-123-456-789
Country
[Select Countries]
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua/Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Chad
Chile
China
Colombia
Congo Brazzaville
Congo Democratic Rep. of
Cook Islands
Costa Rica
Croatia
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faeroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Namibia
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine Autonomous
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saipan
Samoa
Saudi Arabia
Senegal
Serbia
Seychelles
Singapore
Slovak Republic
Slovenia
South Africa
South Korea
Spain
Sri Lanka
St. Kitts/Nevis
St. Lucia
St. Vincent
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tanzania
Thailand
Togo
Tonga
Trinidad/Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
U.S. Virgin Islands
U.S.A.
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Wallis & Futuna
Yemen
Zambia
Zimbabwe
House No./Unit/Bldg.
Street/Village/Barangay
City/Municipality
Region
Security Question
[Select Security Question]
What was your childhood nickname?
In what city did you meet your spouse/significant other?
What is the name of your favorite childhood friend?
What street did you live on in grade school?
What is your oldest sibling's birthday month and year? (e.g., January 1900)
What is the middle name of your oldest child?
What is your oldest sibling's middle name?
What school did you attend for grade school?
What was your childhood phone number including area code? (e.g., 000-000-0000)
What is your oldest cousin's first and last name?
What was the name of your first stuffed animal?
In what city or town did your mother and father meet?
Where were you when you had your first kiss?
What is the first name of the boy or girl that you first kissed?
What was the last name of your third grade teacher?
In what city does your nearest sibling live?
What is your oldest brotherâs birthday month and year? (e.g., January 1900)
What is your maternal grandmother's maiden name?
In what city or town was your first job?
What is the name of the place your wedding reception was held?
What is the name of a college you applied to but didn't attend?
Where were you when you first heard about 9/11?
Select a security question that only YOU can answer.
Security Question Answer
Enter the answer to your account security question
Code Box