PERSONAL INFORMATION
First Name:    * Last Name:    *
Email Address:    *  Business Name:    *
Address:    * Apt:    *
City:    * Postal/Zip Code:    *
Province/State:    Country:    *
Phone Number:    - * Distributor Id:    *
Parent Company:    * Level:    *
LOGIN INFORMATION
Username:    *
Password:    * Re-enter Password:    *
Payment INFORMATION (We will use this information for your future slot orders.)
Payment Method:    * Pay To Name on Checks *:    *
Minimum Payout: * SSN or Tax ID (For US Affiliate Only)*:    *
Company Background
Website name:   * Web site URL:    *
Describe your web site or marketing strategy: How do you plan to market our products? * You can choose more than one Advertisement network
Blog
Business Opportunity Offer
Browser Plug in
per click
per acquisition
Search engine optimization
through Web site
Other
How many unique hits does your website get per day? :    How many years of experience do you have doing online marketing?   
How did you hear about us?   

Terms and Conditions

BY CLICKING ON THE FOLLOWING "SUBMIT" BUTTON, YOU ACKNOWLEDGE THAT YOU HAVE READ AND UNDERSTOOD THIS AGREEMENT AND THAT YOU AGREE TO BE BOUND BY IT. 

I accept these terms.