WebSite Affiliate Program Sign-Up
Note:
• Member website must display banner/link along with their Referral code.
• Custom banners/link must be preapproved by us before using them.
• Subscriber MUST enter website referral code on signup. No exceptions.
• Websites are responsible for any and all taxes on income from this program.
• By submitting this application you agree to all terms and conditions.
• ProAlert.us reserves the right to terminate this agreement at any time.

YOUR INFORMATION
Name:   First & Last Name
Email:   Your Email Address
Phone:

Website: Your Website URL

Checks made out to:
Street :                       
City/Town:                 
State:                         
Zip Code:                   

Desired Password:    


List setup info. and comments:



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***Reproduction or redistribution of material received from this service is not allowed.