| Contact Information |
| Your Name: |
|
| Company: |
|
| Email: |
|
Alternate E-mail
in case above ceases working |
|
| Password: |
(2-16 letters and digits only) |
| Country: |
|
| Phone: |
|
| Street: |
|
| City: |
Postal Code
|
| Your Promotion |
Desired Promo Name
(For use on flyers) |
|
Between 2-12 letters/digits. Short and easy to remember is best!
Examples STARLITE, METRONOME, VALENTINA. |
| Your WEB Site: |
|
Where does our DancePartner.com banner appear on your site?
It must be your home page or other high volume page, not a link exchange page.
You may leave this blank and fill in later if it isn't there yet. |
| Link Back Page: |
|
| Payout Information |
| Social Security # or FEIN: |
(US Only. We're required to report payouts over $600 to the IRS.) |
| Payment Method: |
PayPal
Donation (I am waving my right to all commisions.) |
| PayPal E-mail: |
|
| |
| I have read and agree to the Affiliate Agreement and I am at least 18 years of age. |
|
|
