Liquidation.com Affiliate Application

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Please complete our application and be sure to fill in fields marked with an asterisk (*). We'll send you an email as soon as you are accepted into our Affiliate Program.


	* Requested Username:			(Please provide a preferred username and password for future on-line reporting)
	* Requested Password:
	* Confirm Password:

Site Name:

* URL of Site:

* Name:

* Title:

* Phone:

Fax:

* E-Mail:

* Address 1:

* Address 2:

* City:

* State:

* Province:

* Postal Code:

* Country:

Phone:

Fax:

Same as above

Pay To Name:

Address 1:

Address 2:

City:

State:

Province:

Postal Code:

Country:

Same as above

Name:

Title:

Phone:

Fax:

E-Mail:

Same as above

Name:

Title:

Phone:

Fax:

E-Mail:

Pager:

Help us learn more about your web site and the needs your visitors have. This information will be used to expedite the approval process and help us serve your needs as an affiliate.

What type of site do you have?

Which of the following industries do you cover on your web site?

Apparel & Textiles	Consumer Goods	Electronics & Communication
Furniture	Government	Aerospace & Defense
Office Supplies & Equipment	Transportation	Construction & Building
Other

If "Other", please specify:
How many unique visitors does your site get per month?
*How many page views do your visitors view* per month?**
What is your business tax classification?
What is your Social Security Number or Federal Tax ID, if available?
What is the date your site was established? (mm/dd/yy)

Home Clothing & Accessories Jewelry & Watches Computers & Networking Consumer Electronics General Merchandise
Housewares Tools & Machinery Vehicles Store Fixtures & Equipment

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