Affiliate Program


		May 16, 2012

Signup

Describe Your WebSite
Web site Name:
What is Your Website URL?
Please Confirm Your URL:
Describe Your Website:
Estimated Traffic per Week:

Login Info *This is the information that will be entered each time you login to the affiliates program
Requested Username:
Requested Password:
Confirm Password:

Payee Contact Info *This information belongs to the person/company getting paid
Payee Name:	*This is the name that should appear on the check
Payee Contact First Name:
Payee Contact Last Name:
Tax Classification:
Tax Id/Social Sec. Number:
Address Line 1:
Address Line 2:
City:
State/Province:
Zip or Postal Code:
Country:
Phone Number:
Payee Email:

Technical Contact Info *This information belongs to the person/company that maintains your website
	Check here if Your Payee Contact information and Technical Contact information are identical.
Contact First Name:
Contact Last Name:
Address Line 1:
Address Line 2:
City:
State/Province:
Zip or Postal Code:
Country:
Phone Number:
Contact Email:

	Check here to indicate that you have read and agree to the terms of the Operating Agreement.