Affiliate Enrollment Form

To submit your application, please complete all the fields in the form below. At the present time, we are only able to consider applications from websites with an Alexa traffic ranking of at least 200,000. If accepted, you will earn a 20% commission (paid monthly or until $100 accumulates) on all sales generated from your traffic.

Username:

Password:*

Company:

Site Name:*

Contact Name:

Your Age:

(Must be over 18 years of age)

Address 1:*

Address 2:

City:*

State:*

Zip:*

Country:*

Telephone #:

FAX #:

Email:*

Home Page URL:*

SS# or Tax ID#:

Verification code:
(enter text exactly
as shown in box)

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By submitting this form, you certify that you have read
the AFFILIATE AGREEMENT and accept its conditions.