Welcome to SegPay Affiliate Managment join form


Pay To
Enter the name/company you want us to write on the check
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Password
Confirm Password
The password is case SeNsItIvE. Minimum of 4 chars in length
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What is your company name?



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Email Address
Telephone
Enter a number or two where we can contact you (Office/Home/Cell)
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Screenname/IM id  
What is the best way to communicate with you?
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What is your experience level as an affiliate?
How did you hear about us?
What is your current monthly sales volume (for all programs)?
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What programs are you
currently promoting?
1.
2.
3.
4.
5.
What types of our offers
would you like to promote?
Adult Content
3D Animation
Adult Dating*
Casual Dating*
Webcams*
Everything / Not sure yet
* For Dating and/or Webcams:
How would you like to be compensated?
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What type of medium will you be using to promote our offers?
What device types will you be targeting?
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Minimum Payout
Company Tax-Id
or
Social.S.Number
If you reside in the U.S. or its territories, you are required to complete a W9 form with the correct information and enter a Federal Tax ID or Social Security Number or we will be forced to withhold tax as required by law. We will register a 1099 for all U.S. domestic entities to which we issue combined yearly payments of $600.00 or more.
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Please provide at least
one business reference
1.
2.
3.
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I have read, and agree to SegPay's Terms & Conditions of membership.