Affiliate Partner Enrollment Form
Part 1: Primary Point of Contact
Please provide you primary point of contacts details for affiliate related communications.
Name
*
First Name
Last Name
Email
*
example@example.com
Affiliate Code
Part 2: Business Information
Business Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
As a United States company, we will require a W-9 for tax purposes. We will contact you at the email provided for your primary point of contact to follow-up with an electronic W-9 submission upon completing this form.
Part 3: Commission Payments
Please choose your preferred payment method. PayPal is the fastest, most reliable and secure method of receiving your commission payments.
Payment Method
*
Paypal
Check
Other
Other Payment Method
PayPal Email
Phone Number
Our bank requires a contact's phone number for processing check payments. Checks will be mailed to the Company Address provided above:
I have and agreed to the affiliate terms conditions
*
Submit
Should be Empty: