WomanZone


	WomanZone

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Web Link Affiliate Application

Earnings in Perpetuity

Site Information
Site Name:
URL of Site:
Mailing Address
Business Name:
Address:
City:
State:
Other State/Province:
Postal Code:
Country:
Phone:
Fax:
Primary Contact
Name:
Title:
Phone:
Fax:
E-Mail:
Account Details:
	Same as above
Account Name:
Account No.:
Bank Name:
Bank BSB No.:
Bank Address:
City:
State:
Other State/Province:
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/Mobile:
Please provide a preferred username and password for future on-line reporting. Your new password must be between eight and 30 characters, have at least one letter and one number , and be different from your user name:
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?

What are the categorical classifications of your web site?

Directories	Education	Family/Lifestyles
Online Communities	Personal	Search Engines
Sports	Sweepstakes/ Coupons	Telecommunications/ Internet
News/Information	Shopping	Travel

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?

What is your business tax classification?

What is the date your site was established?

By clicking the Apply button below, you are confirming that you have read and accepted the Terms and Conditions of the Affiliate Network Agreement.