AFFILIATE PROGRAM APPLICATION FORM

Site name:
Site url:
Comments : Any Additional info you’d like to state about your site? i.e your web stats (monthly unique visitor info) Other plans for marketing to your target audience ie. Enewsletters? Do you have a database of visitors that have given you permission to send out emails? If so how many? Any other info we should know?
Contact Name:

Email:
Phone:
Address:
City:
State / Province
Zip / Postal Code:
Country:
How do you want to be paid out?:	Via mail (cheque to above address) or via paypal? Paypal email
Cheque written to (State Name or Company:)
TERMS OF AGREEMENT LINK HERE - IMPORTANT PLEASE READ AND PRINT FOR YOUR FILES
Yes , I have read the terms of agreement and conditions

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