AFFILIATE SIGN UP FORM

Company Info
Company Name
Business type
Business Id
Address
City
State
Zip
Bus Tel
Bus Email
Bus Fax
Phone no. to be displayed on calculator
Email to be displayed on calculator
Login Id
Password
Re-Type Password

Signup Type

No selling is required. Affiliate posts widget or link and earns $50.00 on any enrolled client. Bank info is required where we can remit funds.

Signs client up directly. Custom calculator and enrollment form promotes partner. Earns all revenue above $95.00 on any enrolled client.

Basic Affiliate   

Signs client up directly. Custom calculator and enrollment form promotes partner. Earns all revenue above $95.00 on any enrolled client.

Affiliate Reseller   
No selling is required. Affiliate posts widget or link and earns $50.00 on any enrolled client. Bank info is required where we can remit funds.
Contact Info

Name
Title
 

Email
Work Phone
Cell Phone

Bank Info
Bank Name
Account Number
Routing Number
Type of Account
Secret Word
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Terms and conditions for eCheck payment
Check terms and conditions for Affiliate Reseller