Affiliate Application

If you are re-registering your existing account please enter your Affiliate Code here:

* indicates a required field.

URL Information

Site Label:

URL of Site:

Additional Site:

URL of Site:

When entering a url address, please enter the http://www prefix.

Company Information

* Company Name:

* What is your business tax classfication?

* What is your social security number (individual) or federal tax ID (corporation)

Primary Contact

Title:

* Full Name:

* Phone: - - Ext

Fax: - - Ext

* Email:

Physical Address

* Address Line 1:

Address Line 2:
* City:

Province:
* State: Postal Code:

* Country:

Pay To Address

Same as mailing address
* Payee Name:

* Address Line 1:

Address Line 2:
* City:

Province:
* State: Postal Code:

* Country:

Important Information

By filling in this section, you will help us determine whether you will be placed in our Affiliates Advertising Network. Please complete the questions to the best of your ability. (You must answer All questions below if you entered a URL in section URL Information)

* How did you hear about our program?

* What is the primary categorical classification of your business/website?

Do you design/support your website in house or through an outside service? In-House Outside Service
Name of website content/design primary contact:

Email of your web designer:

How many unique users visit your website each month?

How many page views are logged on your website each month?

Do you currently use EiPrinting as the printer for your banking products? Yes No
What is the date your site was established?

Do you currently pay to advertise on Google, Overture, Yahoo, e-Bay, etc? Yes No

Final Registration

* Please choose your Affiliate registration type:

Requested User Name:

Requested Password:

Confirm Password:

By submitting this application I have read, understood, and I agree to the terms & conditions agreement and FAQ sections of EiPrinting's Affiliate Program.