Affiliate Registration Form
Business Name
*
Business Name
EIN (Tax ID)
*
EIN Number or Tax ID
Date of Establishment
*
/
Month
/
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website Url
Name
*
First Name
Last Name
Account Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Estimated Bookings / Month
*
Less than 15
Between 16 to 34
More than 35
Commission Rate
10% of Commission Sales
Bank Information
Provide bank information to receive your commissions
Bank Name
Bank Name
Routing Number
Routing Number
Payment by Zelle or PayPal
Input your Zelle or PayPal (email or phone)
Account Number
Account Number
Signature
*
Date
*
/
Month
/
Day
Year
Date
Submit
Submit
Should be Empty: