Affiliate Application

Contact

Title

First Name

Last Name

Website

Email Address

Phone Work (11 digits, with country code)

Phone Cell (optional, 11 digits, with country code)

Phone Fax (optional, 11 digits, with country code)

IM Name

IM Service

Location

Address 1

Address 2

City

Zip Code

State

Country

Payment

Tax Class

SSN/Tax ID

Payment To

Marketing

Preferred model:

Top vertical you promote:

Other vertical you promote:

What was your best month’s revenue all time?

Can you submit proof of $1K per week in revenue?

What specific offers do you currently run?

What specific offers have you had the most success with?

What traffic sources are you experienced with?

What traffic sources do you currently use to promote?

What traffic sources would you use if you had a mentor to help you?

How did you get into Affiliate Marketing? Guru/mentor/self taught/etc?

Additional

We may need to conduct a phone or Skype video interview before sending your first payment to verify your identity. Will that be a problem?

Opt in to receive Email from us. You will receive a Thank You Email from ([email protected]) confirming your application has been received. After that you will receive a newsletter once per week highlighting our Top Offers, Network News and other important information. We will never sell your information.

face Contact

map Location

account_balance Payment

assessment Marketing

info Additional

Contact

Location

Payment

Marketing

Additional