Liquid Glucosamine Affiliate Program Application



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Contact Information

Please fill out the name and address of the person in charge of the sponsoring website.
This is the person to whom we will address all correspondence about your participation in the Affiliate Program.

Note
: You must enter a password to protect your account and you must enter the
admin contact email address so that we can contact you if required.

(All fields are required)

First Name:
Last Name:
Company:
Checks Payable To:
Email:
Phone:
Address:
City:
State:
Country:
Zip:
URL where banner will appear:
Choose a Password:
I understand that I may not promote these products/services or this Affiliate Program
        by sending unsolicited mailings (SPAM).
Optional: Enter the email addresses of up to five of your friends, letting them know about this affiliate program. If they follow the email link here and sign up, they will automatically become part of your second tier!

Email #1:
Email #2:
Email #3:
Email #4:
Email #5: