General
1
Fields with an asterisk (
*
) are mandatory.
General
First Name
*
Field is required
Last Name
*
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Email
*
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Email Confirmation
*
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Phone Number
Company
Legal Entity Type
*
Select Legal Entity Type...
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Company/Individual/Website Name
*
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Website/Social/Media
*
http(s)://
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Address
Address 1
*
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Apartment, Suite, etc.
City
*
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Postal Code
*
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Country
*
Select Country...
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Billing
Tax ID / VAT or SSN
Additional Information
Referral Code
Describe the sites and methods used to advertise
*
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What verticals do you promote?
*
Astrology
Auto Insurance
Auto Loan
Casino
Sweeps
Education
Entertainment
Family Assistance
Finance
Financial Assistance
Health & Beauty
Home Improvement
Home Insurance
Home Warranty
Nutra
Solar
Housing
Legal Lead Gen
Mortgage
Senior
Software
Sub Prime
Utilities
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What are your main traffic sources?
*
Comparison Site
Contextual
Direct
Display
Email
Native
Newsletter
PPC
Push
Search
SEO
SMS
SMS (TCPA)
Social
Field is required
What are your top GEOs?
*
US
AU
CA
UK
FR
DE
AT
CH
NL
NO
SE
FI
ES
IT
PO
MX
CL
BR
NZ
IE
BE
SK
PT
SG
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Are you looking for any specific offers? (wishlist)
*
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How many years have you been in the industry?
*
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Are you a:
*
Direct Publisher
Network
Solo Affiliate
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If you are a network do you have?
External sources only
Combination of external and internal
Select your monthly revenue
*
$0 - $1000
$1000 - $5000
$5000 - $10000
$10000 - $50000
$50000 - $100000
$100000+
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What is your Skype ID?
*
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How did you hear about Affilisearch?
*
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