Affiliate Program On-line Application - An Extend A Hand Grab Bar Helping Independent Seniors Stay Independent

Affiliate Program: On-line Application

Before filling out this application, please read our Affiliate Operation Agreement and note that we only accept Affiliates with U.S. and Canadian mailing addresses. Remember, your site must have general audience content in order to be accepted.

Affiliate Sign-up Form:

Name:		As you wish it to appear on your check, unless there is an entry in the "Company" field below.
Address:		Be sure to include ALL your address information, including apartment or suite number, zip or postal code, as this is the location to which your check will be sent.
Email:		MANDATORY: We will send your affiliate linking instructions to you via e-mail, as well as update notifications regarding the Affiliate Program.
Password:		Please enter an alpha-numeric password, no more than 10 characters.
Site URL:		We will visit your site for approval into our Affiliate Program within 24 hours. Please double check your entry.
Company:		If this field is completed, the check will be made out to the company. If you are applying as an indiviual, please leave blank.
Social Secrity FederalTax ID		This field is required for processing your check. Individuals must supply their social security number, companies must supply their tax id number.
		By submitting this form, you indicate that you wish to participate in the Extend A Hand Affiliate Program, that you have reviewed the Affiliate Operation Agreement, and that you agree to be bound by its terms and conditions.