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PUBLISHER APPLICATION FORM

Fill out this form to become a Cashfiesta Publisher.

All fields are required unless otherwise noted.
Please use only Latin characters!


Web Site Information
  
Your Web Site URL:
Does your site offer incentives to users?
Yes   No
  
Contact Information
  
First Name:
 
Last Name:
 
Company Name:
If applicable
Title:
E-mail Address:
Valid Email REQUIRED for password retrieval.
  
Payment Information
   
Affiliate Program Type:
 
Checks Payable To:
 
Address:
 
City:
 
Zip Code:
 
State:
U.S. residents only.
Country:
Note for U.S. residents: In order to comply with IRS regulations, we'll request that you send us a Tax ID/SSN once your earnings exceed $500.
  
Account Information
  
Username:
Minimum 3 characters, not case-sensitive.
Password:
Minimum 4 characters, letters and numbers only. Password is case-sensitive.
Verify Password:
  
Cashfiesta Publisher Agreement
  
By submitting your registration information, you indicate that you agree with the Cashfiesta Publisher Agreement.

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