Affiliate Form

Personal Information
Name*

First NameLast Name
Email*
example@example.com
Company Name
If different from name above
Required Tax & Payment Information
Need to fill Out your W-9? Here is the IRS.gov link: https://www.irs.gov/pub/irs-pdf/fw9.pdf
Outside of the US? Here is the IRS.gov link for our friends outside the US: https://www.irs.gov/pub/irs-pdf/fw8ben.pdf or https://www.irs.gov/pub/irs-pdf/fw8bene.pdf
W-8 or W-9*

Open Files

Cancelof
Banking Information
Name of Bank*
Routing Number*
Account Number*
Name on Account (must match to W9/W8)*
Contact Name*
Contact Phone Number (for verbal verification of bank information)*
How Do You Plan On Promoting?
Select All That Apply
Traffic Sources

Display NetworkNative NetworkSocial NetworkSearchSEOEmail List
List Size*
(Number)
Please Note, you MUST own/manage the list, we DO NOT accept 3rd party mailers
How did you hear about Legacy?*
Should be Empty:

Personal Information