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Affiliate Application
Website Information
Website Name *
Website URL *
Website Categories Choose up to 3 categories
Personal Home Page Arts Business
Education Entertainment Family
Health Home & Living Mature
News Other Regional
Science Shopping Society & Culture
Sports Technology Travel
Women
Brief Description of Website
Website Stats
Website Visitor Demographics Visitor Gender
Mostly Female Mostly Male Both
Visitor Age (check all that apply)
Under 18 18-25 26-35
36-50 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 email address must be valid. Upon completion of your registration, you will receive an email confirming your registration.
Phone Number *
Use numbers only - no dashes, parentheses, etc.
Mailing Address *
City *
State or Province *
If Other, please specify
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 payments to you.
Make Checks Payable To: *
By federal law we are required to maintain Taxpayer Identification Numbers (TIN) for U.S. persons and firms to whom Respond 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 with no dashes.
Taxpayer Identification Number Type *
Required of all U.S. residents.
Tax Classification *
Required for payment purposes
Owner Name (For Sole Proprietorships only)
Required of sole proprietorships.
Please double check the information you have entered above for accuracy.
By clicking Accept at the bottom of this registration page, you certify that the information you have entered in the above fields is correct.
* Required Fields

By clicking Accept you agree to the terms and conditions of the affiliate program.

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