Affiliate Program Application
 
 
Full Name
Year of Birth Must be over 18 yrs of age
Email Address

 Phone Number

xxx-xxx-xxxx
Street Address
City
State or Province

If Other, please specify

Zip or Postal Code
Country
 
 
Business/Organization
Name

Type

 
Important Notice
After acceptance, you will be required to furnish a copy of IRS W-9 Form before any payments are made. A copy of the Form will be emailed to you upon request or you can download a copy from the internet.
By checking this box and submitting this Application you certify that the information you have entered in the above fields is correct and that you agree to the Terms and Conditions of Simp-List Software's Affiliate Program

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