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Fields marked with an * are required fields.

* Choose a Username:	(max 20 characters - letters or numbers only)
(Your Username is your affiliate id and will be visible in your linking code)
* Choose a Password:	(max 20 characters)

Personal Information:

* First Name:		Primary Site Name:
* Last Name:		Primary Site URL:
* Email Address:		* Phone Number:
Company:		Fax Number:
* Address:		ICQ Number:
Address (cont'd):
* City:
* State/Province:
* Zip/Postal:
* Country:

Payment Information:

* Please choose one of the following payment options and fill in the required field. Wire Transfers and ACH account names can be configured within the affiliate interface after your account has been created. Fedex Check and Wire Transfers have a minimum payout level of $500 to offset the cost of transaction. Your choice is not permanent. You can change your method of payment later, if desired.

	Standard Check		Name on Check:
	Fedex Check		Name on Check:
	Wire Transfer		Details can be entered within the affiliate interface.
	ACH (USA Only)		Details can be entered within the affiliate interface.

Other Information:

* As an affiliate, how would you best describe your experience level?

* Are you planning to advertise affiliate links on websites containing adult themes and/or materials?

Terms & Conditions:

	* I have read and agreed with all of the terms & conditions
	* I have read and understand the new U.S. Federal CAN-SPAM Act and the potential fines that may result.