Affiliate Program Application

Your Information
* (10 characters max)
* (10 characters max)
*
*
Company Name
Your Position
Email *
For correct payments, ensure this is a valid address

- or -

Australian affiliates - if an ABN is not provided, GST will not be paid. Further 47% will be witheld for tax.
Address *
City *
State
Zip Code/
Postcode *
Country *
Phone
Fax
Website Information
Address (URL) *
Website Name *
Description
Comments
Payment Details
All payments will be made periodically via PayPal. PayPal is an account-based system that lets anyone with an email address securely send and receive online payments using their credit card or bank account. For this, please ensure that you provide a valid email address. If you are not a PayPal member, you will receive a notification with your first payment. For information please visit www.paypal.com.
Miscellaneous Information
Send an email when you make a sale?
Yes, I have read and accepted the LIVE IN australia.com Affiliate Terms & Conditions and the LIVE IN australia.com Privacy Policy. By clicking through this box you agree to be bound by the terms and conditions of the LIVE IN australia.com Service Agreement and the LIVE IN australia.com Privacy Policy. *
I am at least 18 years of age. *