Ultimate Shades Affiliate Program

Affiliate Application

Site Information
Site Name:
URL of Site:
Mailing Address
Address 1:
Address 2:
City:
State:
Zip Code:
Country:
Phone:	Fax:
Primary Contact
Name:
Title:
Phone:	Fax:
E-Mail:
Pay To Address
Same as above
Pay To Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Country:

Important Information
By filling in this section, you will help us determine whether you will be placed in our Affiliate Advertising Network. please fill out these questions to the best of your ability.

How many unique users visit your web site each month?
How many impressions does your web site receive each month?
What is your business tax classification?
What is your Social Security Number (individual) or Federal Tax ID (corporation)?