Pay To |
Enter the name/company you want us to write on the check
|
------------------------------------------------------------ |
Password | |
Confirm Password | The password is case SeNsItIvE. Minimum of 4 chars in length |
------------------------------------------------------------ |
What is your company name? | |
|
|
------------------------------------------------------------ |
Email Address | |
Telephone | Enter a number or two where we can contact you (Office/Home/Cell) |
------------------------------------------------------------ |
Screenname/IM id |
|
What is the best way to communicate with you?
|
------------------------------------------------------------ |
What is your experience level as an affiliate?
|
How did you hear about us? | |
What is your current monthly sales volume (for all programs)?
|
------------------------------------------------------------ |
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?
|
------------------------------------------------------------ |
What type of medium will you be using to promote our offers?
|
What device types will you be targeting?
|
------------------------------------------------------------ |
Minimum Payout | |
|
Note: Wire Transer - $1,000 minimum, $25 fee
|
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.
|
------------------------------------------------------------ |
Please provide at least one business reference |
1. 2. 3. |
------------------------------------------------------------ |
|
I have read, and agree to Segpay's Terms & Conditions
of membership.
|
| |