| Contact Information |
| Your Name: |
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| Company: |
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| Email: |
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Alternate E-mail
in case above ceases working |
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| Password: |
(2-16 letters and digits only) |
| Country: |
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| Phone: |
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| Street: |
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| City: |
Postal Code
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| Your Promotion |
Desired Promo Name
(For use on flyers) |
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Between 2-12 letters/digits. Short and easy to remember is best!
Examples STARLITE, METRONOME, VALENTINA. |
| Your WEB Site: |
If you have more than one web site, simply enter your most popular one. |
Where does our DancePartner.com banner appear on your site?
Leave this blank and fill in later if it isn't there yet.
If you have multiple sites, simply enter the address for one of them. |
| Link Back Page: |
(Optional)
|
| 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: |
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| I have read and agree to the Affiliate Agreement and I am at least 18 years of age. |
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