Due to security reasons, we will need you fill out the following information to re-register for an online affiliate account.
This does not affect your current status as an affiliate, it is an additional measure to keep your information more secure online.
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Contact Information
Verify Shipping Address
We found a verified address for your shipping entry.
Please select from the verified address(es) below or use your original entry.
Note: Standardized addresses help to ensure the most efficient delivery of your order.
Your Entry
The matching standardized address
ADDRESS VERIFICATION
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Commission Check Payable To
Same as primary contact
*Payee:
Verify Shipping Address
We found a verified address for your shipping entry.
Please select from the verified address(es) below or use your original entry.
Note: Standardized addresses help to ensure the most efficient delivery of your order.
Your Entry
The matching standardized address
ADDRESS VERIFICATION
We are unable to verify your address as entered. Please confirm that it was entered correctly.
Security Question
* This question will help us verify your identity should you forget your password.
Select a Security Question:
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