New Affiliate Application

Contact Information
* First name:
* Last Name:
* Make Checks Payable to:
Company (if applicable):
* Type of  Business:
* Address:
* City, State Zip:
* Country:
* Phone:
* Email:

Same Address?

If the mailing address above is the same as the Payee Address below, check the box to the left.  Otherwise, enter the information below:

Payee Address
* Payee Address:
* Payee City, State Zip:
* Payee Country:

Site Information

We are currently looking for sites with at least 100 visitors per day (not hits, unique visitors).  If you have less, please continue promoting your site and reapply when better positioned. We want all affiliates to succeed and feel that with any less visitation, you would be discouraged by the results.  
* Web Site Title:
* Web Site Address:
* Visits Per Day:
* Password:
* Confirm Password:
Comments / Questions:

Payment Information

If you are in the U.S. your social security number (PERSONAL) or your Tax ID number (CORPORATION/BUSINESS).   This is for TAX reasons only (we do not share this information or use it otherwise). If the checks are being made payable to you personally, and you are not a corporation, please enter your social security #. If the checks will be made payable to your corporation or company if it has a tax ID of it's own, enter your Federal Tax ID. If you or your company are in the U.S., you must enter one or the other to be accepted. Checks will be paid in US funds(dollars) only and will be cut after the month end in which you accrue US$50 in fees due. Your statistics page will provide the current number of successful quotes and balance due within 21 days of month end. Unlike many affiliate programs in the automotive industry, we have no interest in holding your money until the end of each quarter. We get paid monthly, so should you.
* Social Security Number:
* Tax ID Number:

Terms & Conditions
* By checking this box, I affirm that I have read and agree to the terms set forth in the Affiliate Agreement, located at: http://www.4freequotes.com/affiliate/agreement.html
and further wish to become an Affiliate subject to the terms and conditions of said agreement. I declare that the above information I have supplied is true and I understand that I am digitally signing this form upon clicking the submit button below. 


* Denotes Required Fields