Application
  Application
 
 
* Only one website per affiliate application. Please complete a new application for each website.

  MyFax™ Affiliate Application Form
 
Contact Information:
 
First Name:*
  
Last Name:*
 
Company:*
  
Phone:*
 
Email:*
  
Confirm Email:*
 
Address:*
  
City:*
 
State/Province:*
  
Country:*
 
Zip/PC:*
  
URL where banner(s) will appear:*
 
Monthly Website traffic:
  
 
Payment Information:
 
Choose a password:*
(at least 6 characters)
  

Checks Payable to:*
 
Corporate GST Number:
(Canadian residents only)*
  
 
Preferred currency of payment:*
US
Canadian		  
 
MyFax Affiliate Agreement:*
 
I agree to the terms of the MyFax Affiliate Agreement
I understand that I may not promote MyFax service by sending unsolicited mailings.


  
  * Offer valid until May 31, 2006