Affiliate Application

Red Gorilla Affiliate Application

(All required sections are highlighted in red)

Site Information

Site Name:

URL of Site:

Mailing Address

Address 1:

Address 2:

City:

State:

Province:

Postal 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:

Province:

Postal Code:

Country:

Accounting Contact

Same as above

Name:

Title:

Phone:         Fax:

E-Mail:

Technical Contact

Same as above

Name:

Title:

Phone:         Fax:

E-Mail:

Pager:

Please provide a preferred username and password for future on-line reporting:

Requested Username:

Requested Password:

Confirm Password:

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.

What are the categorical classifications of your web site?

Business-to-Business Computer/Technology Education Entertainment

Finance/Investing News/Media Office supplies Professional services

Shopping Small Business Sports/Hobby Other

If "Other", please specify:

How many unique users visit your web site each month?

How many page views are logged on your web site each month?

What is your business tax classification?

What is your Social Security Number (individual) or Federal Tax ID (corporation)?

What is the date your site was established?

By applying, I have read, understand and agree to be bound by the
Red Gorilla Affiliate Program Agreement.

Affiliates Application