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This site will be reviewed for acceptance into the Affiliate program. If no site exists, the application will be declined.
Website Name
Website URL
Contact Information
Important: Your email will be used for business purposes only. See our Privacy policy for further details.
Email Address
Contact Name
Telephone Number
Checks Payable To
Address
City
State / Province
Zip Code
Country
Tax ID / SSN*
*Only required if located in US Note: The Tax ID/S.S.# field must be formated as follows: The numbers must contain dashes. Tax ID: (xx-xxxxxxx) S.S.#: (xxx-xx-xxxx)
Funds Distribution
Note: Affiliates may chose to have their checks sent overnight for a $15 fee. Wire transfer fees are $15 for US and $25 for international. A minimum payout of $50 (US) is required each month. A minimum payout of $500 (US) / $1000 (International) must be met for all wire transfers.
Minimum Payout
Desired Payout
Standard Check
Overnight Check (Fee: $15 US / $25 International)
Wire Transfer *Fields Below Req'd. (Fee: $15 US / $25 International) Direct Deposit (Click for Details)
Bank Name*
Bank Branch*
Bank Address*
Bank Telephone*
Bank Routing*
ABA/Swift*
Bank Acct. Number*
Beneficiary Name*
Beneficiary Address*
Beneficiary Telephone*
Login Information
Note: Username must start with a letter, and may contain letters, numbers, and underscores. Password is case-sensitive. Both the username and password must be less than 10 characters long.
Username
(max 10 Characters)
Password
(max 10 Characters)
Verify Password
(max 10 Characters)
Referral Information
Note: Please enter the affiliate id of the affiliate who referred you to us. If no affiliate referred you, just leave the space blank.
