Business Assistance Affiliate Program

Affiliate Signup Form

Personal Information

* Required Fields
First Name *	Enter First Name
Last Name *	Enter Last Name
Company	Enter Company
Address 1 *	Enter Address
Address 2	Enter Address 2
City *	Enter City
State *	Enter State
Country *
Zip Code *	Enter Zip
Phone *	Enter Phone
Fax	Enter Fax
Payment Preference *
Tax ID	Enter a Valid Tax ID

User Account Information

Username *

Password *

Confirm Password *

Email Address *

Paypal Email

Website URL *

Are you over 21 years of age? *

Anonymous email addresses are not allowed such as Hotmail, Yahoo, Gmail or any other free web based email addresses. This because they are not traceable to a real person and have no place in legal binding commercial transactions or agreements. Use your real ISP provided address or your established .com .org etc. domain email address. This is a legal binding business agreement. Use your real non cell phone, land based, listed phone number.

I accept and will follow all Terms of Service

206-203-0860

Affiliate Support