Use this form to signup Affiliates for your account. All fields marked by the * character are required. Be sure to enter correct and complete information. If the information is incomplete or inaccurate, payment may be delayed.

Enter the following:

• Site URL - The base URL of the affiliate website. For example, http:// www.yourwebsite.com. *

• First Name - The first name or given name of the affiliate. *

• Last Name - The last name or surname of the affiliate. *

• Company Name - The affiliate's company or business name. *

• Check Name - The name for the affiliate account printed on the CCBill check. This name will appear on the check exactly as typed. *

• Username - The login ID or user name to use for the affiliate account. The username and password must be between 6 and 15 characters in length. It can only contain letters, numbers, and underscores; no other characters are allowed. *

• Password - The affiliate account's password. The password can only contain letters and numbers; no other characters allowed. The password must contain at least one uppercase letter, one lowercase letter, and one number. *

• Re-type Password - Re-type the password to confirm. *

• Address 1 - The main part of the address, i.e., street information, P.O. box, etc. CCBill sends the check to this address.

• Address 2 - The second part of the address, i.e., Apt number, Suite number, other information, etc. CCBill sends the check to this address. This must be a complete mailing address.

• City - The city for the mailing address for the affiliate account. *

• State/ Province - The State or Province for the mailing address for the affiliate account.

• Zip/ Postal Code - The Zip/ Postal code for the mailing address. If the address has a Zip/ Postal code enter it here, otherwise enter "xx". *

• Country - The country for the mailing address for the affiliate account. *

• Email - Enter the affiliate account's business or personal email address. This is a required field. *

• Tax ID or SSN - The company tax ID number or personal SSN (Social Security Number). Do not omit dashes! The tax ID is required for U.S. charges only. This is in the format 12-3456789 and is used for business billing. For personal billing, use the Social Security Number in the format 123-45-6789. *

• Address Viewable - Whether or not to allow the CCBill client to view the Affiliate address.

• Referred By - You may enter an account number of another Affiliate who will receive credit for the signup.

You may also signup Affiliates with the Affiliate Signup Form. To do so, modify the Signup Template and place it on the required website. The form may be used by you or your affiliates.