Affiliate Application

	Affiliate Program
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Site Info
Enter a name for your site and provide its URL address.
Site Name:
URL:
Confirm URL:
Primary Contact
Enter the contact information for the person who will receive all communications concerning the affiliate program.
Name:
Title:
Phone:	Fax:
E-mail:
Confirm E-Mail:
Pay To Information
Enter the name that you want to appear on the commission checks.
Pay To Name:
Enter the primary contact's mailing address.
Address 1:
Address 2:
City:
State:
Province/Other:
Postal Code:
Country:
What is your business tax classification?
Tax Identification Number [Business/Individual]:
Please provide a preferred username and password for future on-line reporting:
Enter a user name and password. You will use this log on to access Reporting.net.
Requested Username:
Your password must be different from your user name, contain between eight and 30 characters, and have at least one number and one letter.
Requested Password:
Confirm Password:

Important Information

What is the primary categorical classification of your web site?

What are the categorical classifications of your web site?

Auto	Corporate Info	Directories	Education
Entertainment	Family/Lifestyles	Finance	Government
News and Information	Online Communities	Personal	Search Engines
Shopping	Sports	Sweepstakes/Coupons	Telecommunications/Internet
Travel