Affiliate Program Application Form

	Site Information
	Site Name :
	URL of Site:
	Mailing Address
	Address 1:
	Address 2:
	City:
	State/Province:
	Zip/Postal Code:
	Country:
	Phone:
	Fax:
	Primary Contact
	Name:
	Title :
	Phone :
	Fax :
	E-mail :
	Pay to Address
	Same as above
	Pay To Name :
	Address 1 :
	Address 2:
	City:
	State/Province:
	Zip/Postal Code:
	Country:
	Phone:
	Fax:
	Important Information
	How Many unique users visit your web site each month ?
	How many page views are logged on your web site each month ?