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Primary email: Please enter the email address that we should use for all correspondence & payments, etc.
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| Primary email: |
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Payee: Please enter contact information of the person or company to whom we should make the checks payable.
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Payee name: |
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Enter the exact name that should appear on the check. If the check is to be mailed to an someone other than the Payee, enter "Attention:" and the name of the recipient in "Address Line 1" below.
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| Address line 1: |
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| Address line 2: |
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| Address line 3: |
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| City: |
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| State, province, or region: |
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| Zip or postal code: |
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| Country: |
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| Phone number: |
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Payee Tax Information (for U.S. citizens or residents): Please enter your U.S. social security number (for individuals) or U.S. tax ID (for corporations).
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| Tax ID Number: |
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| Tax Classification: |
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Contact: Please enter contact information for the person responsible for maintaining your Web site.
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| Contact name: |
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| Address line 1: |
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| Address line 2: |
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| Address line 3: |
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| City: |
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| State, province, or region: |
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| Zip or postal code: |
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| Country: |
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| Phone number: |
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Information About Your Web Site
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The name
of your Web site: |
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| The URL of your
Web site: |
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| How did you learn about our Partner Program? |
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What Does Your Web Site Offer
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Description & comments:
(Decribe your site in 10 lines or less) |
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