Affiliate Program | Affiliate FAQ | Affiliate Agreement

HomeGain Affiliate Application


* indicates required fields

Site Information
*Site Name:
*URL of Site:
Mailing Address
*Address 1:
Address 2:
*City:
*State (if US):
*Province (if Canada):
*Postal Code:
*Country:
Phone:	Fax:
Primary Contact
*Name:	(suffix)
Title:
*Phone:	Fax:
*E-Mail:
Pay To Address
	Same as above mailing address
*Pay To Name:
*Address 1:
Address 2:
*City:
*State (if US):
*Province (if Canada):
*Postal Code:
*Country:
Accounting Contact
	Same as above
Name:
Title:
Phone:	Fax:
E-Mail:
Technical Contact
	Same as above
Name:
Title:
Phone:	Fax:
E-Mail:
Pager:
Please provide a preferred username and password for future on-line reporting:
*Requested Username:
*Requested Password:
*Confirm Password:

Important Information
By filling in this section, you will help us determine whether you will be placed in our Affiliate Advertising Network. Please fill out these questions to the best of your ability.

*What is the primary categorical classification of your web site?
If "Other", please specify:
How many unique users visit your web site each month?
How many page views are logged on your web site each month?
Please enter your tax classification status and your tax ID. (Please note: This information will be used to report the revenue you earn as a HomeGain affiliate to the IRS.)
What is your business tax classification?
What is your Social Security Number (individual) or Federal Tax ID (corporation)?

I have read and agree to the HomeGain Affiliate Agreement.

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