General
1
Fields with an asterisk (
*
) are mandatory.
General
First Name
*
Field is required
Last Name
*
Field is required
Email
*
Field is required
Email Confirmation
*
Field is required
Phone Number
*
Field is required
Company
Company/Individual/Website Name
*
Field is required
Website/Social Media
*
http(s)://
Field is required
Example Offer Landing Page / Product Page
*
http(s)://
Field is required
Address
Address 1
*
Field is required
Apartment, Suite, etc.
City
*
Field is required
Postal Code
*
Field is required
Country
*
Select Country...
Field is required
Additional Information
Referral Code
Payment Terms
*
Field is required
Tax ID
*
Field is required
Company Number
*
Field is required
Billing Email
*
Field is required
Billing Address (If different)
Billable confirmation by 15th?
*
Yes
No
Field is required
Do you own any offers?
*
Yes
No
Field is required
If yes, please list some examples below
Payment Models
CPL
CPA
Revshare
CPI
Hybrid
Other
CPC
Apply
