Affiliate Agreement

Be sure to type in the correct name and address -- this
information will be used when I send your commission checks!

      First Name:     
       Last Name:     
   Email Address:     
Address (no PO Box):  
 Zip/Postal Code:     

Please check this box signifying that you understand and agree that you are working independently and are responsible for calculating and paying your own taxes on all income you generate as a result of this affiliate program.

Check the box to signify that you had read the affiliate agreement, signed it, and faxed back to 212-202-7803

Check the box to signify that you had filled up the above form