Holistic Junction: Affiliate Partnership Program Enrollment


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Affiliate Partnership Program Enrollment

Basic Affiliate Program Enrollment Form

(Schools not included)

By submitting the following form, you are enrolling your site as an Affiliate Partner and agree to abide to the terms of Holistic Junction's Affiliate Partnership Program:

Company and site information

Company name:*

Type of business:*

Website URL:*

SSN or Tax ID No.:*

Primary contact

First name:*

Last name:*

Phone:*

Alternate phone number:*

FAX:*

Email:*

Mailing address

Address:*

City:*

State/province:*

Zip/postal code:*

(Required for US and Canada)

Country:*

Pay to address

Same as above

Pay to name:*

Address:*

City:*

State/province:*

Zip/postal code:*

(Required for US and Canada)

Country:*

Password to log in for on-line reports
(banner traffic statistics and activity under your affiliate account)

Password:*

Re-enter password:*

Agree to Disclaimer & Terms

I have read and agree to the Holistic Junction
Affiliate Partnership Program Disclaimer & Terms.

* Indicates a required field

We NEVER rent or sell your personal data (including Email address) to ANYONE. All information that you provide is held STRICTLY CONFIDENTIAL.

November 7, 2009