APR

WHEN YOU SUBMIT THIS FORM, IT WILL AUTOMATICALLY GENERATE YOUR AFFILIATE PROGRAM I.D. #. YOUR COMPUTER IP ADDRESS WILL AUTOMATICALLY BE RECORDED. PLEASE BE CERTAIN ALL INFORMATION IS GIVEN. INCOMPLETE SUBMISSIONS CAN NOT BE ACCEPTED UPON REVIEW. THIS INFORMATION WILL BE USED FOR YOUR 1099 W-9 SUBMISSION. ACCURACY IS REQUIRED UNDER FEDERAL LAW.

Please provide the following contact information:

Name

Organization

Street

Address

(cont.)

City

State

Zip

Your Zip + 4 is required.
Click HERE if you need the USPS look-up.

Work Phone

FAX

E-mail

Select Your TAX ID Type (in drop down box) and then enter your TAX ID NUMBER, below.		Select the AFFILIATE PROGRAM Type you wish to participate in (in drop down box), below.
			EXCLUSIVE AFFILIATES will be sent FORM-EA. This must be completed and returned before acceptance into the program.

I ATTEST TO AND CONFIRM THE ACCURACY AND COMPLETENESS OF THE INFORMATION
PROVIDED HEREIN. I CONFIRM TAX REPORTS MAY BE FILED BASED UPON THE ABOVE
INFORMATION AND AGREE WAGE AND TAX REPORTS SHALL BE SENT TO ME VIA THE EMAIL
ADDRESS GIVEN ABOVE IN LIEU OF ANY OTHER FORM OF TRANSMISSION.