maxRefer - Affiliate Program Application

maxRefer.com - use the power of word-of-mouth to increase your web site traffic. One of the most effective web marketing strategies available to web site owners.

"A Tell-a-Friend system on steroids!"

Thank you for selecting the maxRefer.com Affiliates Program!

Before submitting your application, please review the Affiliate Operating Agreement. This details the terms and conditions of your participation in the maxRefer.com Affiliate Program.

Please fill out the following to apply.

* indicates required fields
Site Information
Site Name:	*
Site URL:	*
Mailing Address
Address 1:	*
Address 2:
City:	*
State:	* Province/Region (if outside USA)
Postal Code:
Country:	*
Phone:	* Fax:
Contact
Name:	*
Title:
Phone:	* Fax:
E-Mail:	*

Pay To Name

Pay To Name:	*

Pay To Address
	Same as above (If selected, skip to the next section)
Address 1:	*
Address 2:
City:	*
State:	* Province/Region (if outside USA)
Postal Code:	*
Country:	*

Your account information:
Username:	* (6-20 characters - letters and numbers only)
Password:	* (6-20 characters - letters and numbers only)
Confirm Password: (Re-enter)	*

Demographic & Accounting Information:
How many "unique" users visit your web site each month?	*
How many "page views" does your web site receive each month?	*
What is your business tax classification?	*
What is your Social Security Number (individual) or Federal Tax ID (corporation)?	*
When was your site was established? Enter date as "MM/DD/YYYY" (ie, 05/10/1999)
How did you learn about the maxRefer.com Affiliates Program?

Site Description & Comments:
Briefly describe your site. (250 character max) characters left

Once you've submitted your application, you will be sent information about your options for linking to maxRefer.com. You can also update the information on this page at anytime through your Affliate Account Control Panel.
I am requesting application to the maxRefer.com Affiliate Program and have reviewed and agree with the Affiliate Operating Agreement. *

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