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Affiliate Marketer Application Form
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561-886-7800
Personal Information
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Last Name*
Email*
Phone Number*
Address*
City*
State*
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Experience and Goals
How long have you been involved in affiliate marketing? *
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1-2 years
3-5 years
5-10 years
10+ years
Which affiliate networks are you currently part of?*
Please describe your most successful affiliate marketing campaign*
What are your goals as an affiliate marketer?*
Website and Marketing Information
Main URL*
Social Media Profiles (Include links):
Facebook*
Twitter
Instagram
LinkedIn
Other
Compliance
Do you have a TCPC Litigator or The Blacklist Alliance account?*
Select From List
Yes
No
Tell us about your compliance procedures at your company.*
Preferred Marketing Channels*
Website
Social Media
Email Marketing
Content Marketing
Paid Advertising
Other
Estimated Monthly Traffic*
Target Audience:
Age Group*
18-24
25-34
35-49
49-64
65+
Target Audience Location*
Interests*
Date*
By checking this box, you agree that your electronic signature (hereinafter referred to as "E-Signature") is the legal equivalent of your manual signature. You consent to be legally bound by this agreement's terms and conditions. You agree that we may provide you with any communications in electronic format, including email, SMS or traditional mail. By agreeing to this consent, you confirm that you can access the electronic records in the formats described above, and that you have an email account with the capacity to receive emails from us.
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Buy Calls Now
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561-886-7800
First Name*
Last Name*
Telephone*
Email*
Business Name & dba*
Address
City
State*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
36. Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code*
What traffic sources do you accept? *
Inbounds
Transfers
Do you accept ?*
Onshore
Near Shore
Offshore
Please tell us about your business model.*
Verticals*
Auto Insurance
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561-886-7800
First Name*
Last Name*
Telephone*
Email*
Business Name & dba*
Address
City
State*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
36. Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code*
Call Traffic Sourcing*
Generated In-House
Brokered
Both
Are your calls generated*
onshore
near shore
offshore
How do you generate your calls?*
Verticals *
Auto Insurance
Affordable Care Act
Bathroom
HVAC
Medicare
Motor Vehicle Accident
Plumbing
Roofing
Reverse Mortgage
Re-Fi
U65
Windows
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