Affiliate Account Application Form
To apply for your free Affiliate Account, please fill out the form below.
All fields in red are required.
Your Name:
Company Name:
Address: (If PO Box,
show physical address too.)
City, State, Zip:
Phone: (Include Area Code. Example: 111-222-3333)
Fax: (Include Area Code. Example: 111-222-3333)
Email Address:
IMPORTANT: You must be an Instantpublisher.com member
and this email address must match your Instantpublisher.com
member email address if you desire to view your affiliate
account status on-line.
Website Address(es)
Which Will contain Our Link
(1000 characters max):
Any additional information
you wish to tell us about your
business or sites
(1000 characters max):

Agreement:
I have read and agree to the above Agreement regarding this account.