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AFFILIATE INFORMATION
required First Name enter your first name here
required Last Name enter your last name here
required Email enter your personal Email Address here
required Company enter your company name here (or your personal name if you are not signing up on behalf of any company)
required Your Website enter your website url,if none please enter n/a
required Address enter your address here
required City enter your City here
required State/Province enter your State or Province here
required Zip/Postal Code enter your Zip or Postal Code here
required Country select your Country here
required Phone enter your Phone Number here
  Fax enter your Fax Number here
required Password enter the password you will use to log into your Affiliate Account here.
required Password Check please type again the password here
COMMISSION PAYMENT PREFERENCES
Preferred Method of Payment
Check by Mail
Make Checks Payable to:
if checks should be made payable to name other than "FirstName LastName", enter it here
PayPal
PayPal Email:
if checks should be made payable to e-mail other than main e-mail address, enter it here
AFFILIATE AGREEMENT

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