Referral Partner Enrollment Form

All fields required.

Your Personal Information

Payment Information

Will we issue commission payments to you personally or to a business? *

Me personally
My business

Are you a US resident or business who/that files an annual tax return with the IRS? *

Yes, I am a US resident or business and file with the IRS.
No, I am non-Us and am not required to file with the IRS.

If you answered 'Yes' above, you MUST provide us with your Social Security Number. If you indicated we will pay commissions to you personally, enter your SSN using the following format: 123-45-6789.

If you indicated we will pay commissions to your business, enter your EIN using the following format: 12-456789.

There are no exceptions. Your submission is secure and submitted data is encrypted.

If you answered 'No' above, please enter "Non-US" in the data field below. The form will not accept a blank field.

Failure to provide this information or providing false or misleading information could result in a delay or forfeiture of commissions earned.

How would you like to be paid? *

PayPal - payments issued monthly regardless of balance.
Check - payments issued quarterly or when balance is $200 or greater, whichever occurs first.

Submission of this form indicates that you have read and accept the Referral Partner Agreement.