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Affiliate Program Application

Contact Information

Please fill out the name and address of the person in charge of the sponsoring website. This is the person to whom we will address all correspondence about your participation in the Associates Program.

Note: You must enter a password to protect your account
and you must enter the admin contact email address so that we can contact you if required.

Adminstrative Contact Information
Company Name:
First Name:
Last Name:
Address1:
Address2:
City:
State:
Postal:
Country:
Phone:
Fax:
Email:
Confirm Email:
	Please double check your email address in the above field, as this is where we will be sending you all of your information.

Payee Contact Information Please fill out the name and address of the person to whom we should send referral payments earned through this program. Please fill out all of the fields, even if they are the same as above, as this information is automatically imported into our database and what you input here will be what name appears on your monthly check and where the check is mailed to.
Click here if info is same as Admin info
Company Name:
First Name:
Last Name:
Address1:
Address2:
City:
State:
Postal:
Country:
Phone:
Fax:
Email:

Tax ID:
Password :
Password (confirm):
Website URL:
Website Title:

Website Description:

You will be contacted within 5 minutes by email with your special assigned URL and easy instructions on how to get everything set up immediately.

Keyword 1:

If you experience any problems, please email HELP

For assistance call 1- 800-801-9934 and ask for
Andrea, Renata, Ed, Shlomo, or Chuck

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