| Website Information
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| Website Name |
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| Website URL |
|
Website
Categories |
|
Personal |
|
Arts |
|
Business |
|
Education |
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Entertainment |
|
Family |
|
Health |
|
Home & Living |
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Mature/Adult |
|
News |
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Other |
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Regional |
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Science |
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Shopping |
|
Society & Culture |
|
Sports |
|
Technology |
|
Travel |
|
Women |
|
|
Brief Description of Website |
|
| Website Stats |
|
Website Visitor
Demographics |
Mostly Female
Mostly Male
Both |
| Age |
|
Under 18 |
|
18 - 25 |
|
26-35 |
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36 - 50 |
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51 - 65 |
|
Over 65 |
| Does your Website... |
|
Require a login?
Yes
No |
|
Offer rewards/compensation?
Yes
No |
|
Donate a portion of proceeds to an organization?
Yes
No |
|
Do you manage more than one Website?
Yes
No |
| |
| Contact Information
|
| First Name |
|
| Last Name |
|
| Email Address |
Your username and password will be sent to this e-mail address.
Becareful |
| Phone Number |
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|
Mailing Address |
|
|
City |
|
|
State or Province |
|
|
Zip or Postal Code |
|
|
Country |
|
| |
| Payment Information
|
|
IMPORTANT: Please read the information in this section carefully
and ensure that the information you enter is correct. Failure to
do so may unnecessarily delay commission payments to you.
|
| |
|
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|
Make Checks Payable To: |
|
| |
|
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|
By federal law, we are required to maintain Taxpayer
Identification Numbers (TIN) for U.S. persons and firms to whom
we makes disbursements. The number you provide MUST
correspond to the payee you have identified above. For
individuals, this number is your Social Security Number (SSN).
For other entities, it is your Employer Identification Number
(EIN). |
Taxpayer
Identification
Number |
Required of all U.S. residents.
Enter your nine-digit Tax ID number. |
| |
|
|
Taxpayer
Identification
Type |
Required of all U.S. residents. |
| |
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|
Tax
Classification |
|
| |
|
|
|
Owner Name |
(For Sole Proprietorships only) |
| |
|
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|
Please double check the information you have entered
above for accuracy. |
| |
|
|
| Yes! |
|
We may send you information about our program on a periodic basis. |
| Yes! |
|
I'd like to receive the monthly Newsletter to be informed of new
features, updates, and new merchants who have joined the network. |
| Yes! |
|
I'd like to be notified of any new promotions being offered by
your merchants on a periodic basis. |
| |
|
|
|
By clicking Accept at the bottom of this registration
page, you certify that the information you have entered
in the above fields is correct.
By clicking Accept you agree to the terms and conditions of
EZCashCafe, Inc..
|
