Affiliate Program Application - Phoenix Rising Books

Phoenix Rising Books

Associate Program Application

Contact Information

Please fill out the name and address of the person in charge of the sponsoring website. This is the person to whom we will address all correspondence about your participation in the Associate Program.

Note: Fields marked with * are required fields. You must enter a password to protect your account and you must enter the admin contact email address so that we can contact you if required. You are not obligated to provide a website description, however inclusion does assist us to determine your target market and therefore provide you with specific promotional ideas. We use the information in the Company Name field to generate commission cheques. If you are not operating a company, please write in this field the name you want the cheques made out to.

Administrative Contact Information
Company Name: *
First Name:*
Last Name*:
Address1:*
Address2:*
City:*
State:*
Post Code*:
Country:*
Phone:*
Fax:*
Email:*
Confirm* Email:
	Please double check your email address in the above field, as this is where we will be sending you all of your information.

Payee Contact Information Please fill out the name and address of the person to whom we should send referral payments earned through this program. Please fill out all of the fields, as this information is automatically imported into our database and what you input here will be what name appears on your commission cheque and where the cheque is mailed to. If the contact details are the same as the Administration details, click on the box.
Click here if info is same as Admin info
Company Name:
First Name:
Last Name:
Address1:
Address2:
City:
State:
Postal:
Country:
Phone:
Fax:
Email:

ABN Number(1)
Password :
Password (confirm):
Website URL:
Website Title:
(1) Note: If you operate within Australia and fail to provide your ABN number we are obliged to subtract withholding tax from your commission
Website Description:

You will be contacted within 5 minutes by email with your special assigned URL and easy instructions on how to get everything set up immediately.

If you experience any problems, please email sue@phoenixrisingbooks.com

31a Glebe Point Road, Glebe, NSW, 2037

Phone 61 (0) 2 9566 2157, Fax 61 (0) 2 9518 4696

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