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If you wish to register as an affiliate, please fill out the form provided for you below. The Payment Method drop-down menu lets you pick how you want to be paid for your traffic, and the Minimum Payout drop-down menu lets you pick the amount of payment you have to reach in order to be paid.

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Account Information
*Username: *Company:
*Password: *Verify Password:
*URL:  
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Contact Information
*Email: *Verify Email:
*Phone:    
ICQ: AIM:
Skype: MSN:
Mailing Address
*First Name: *Last Name:
*Address: Address (cont):
*City: State:
*Zip Code: *Country:
Payment Details
Payment Method: Minimum Payout:
*Account Name: *Bank Name:
*Bank Address: *Bank City:
*Bank State: *Bank Zip:
*Bank Country: *Account Number:
Bank Swift: Address:
Account Iban: Address (cont):
State: City:
Country: Zip Code:
US Routing Number:  
Tax ID/VAT: Only if in US