Affiliate Registration (Part 1 of 3)

Contact Information:
All of the information that we request is for our use only, and will not be given or sold to third parties. We require contact information so that we can reach you in the event of problems.

Full Name:
Company Name:
Telephone: Fax:

Web Information
Provide the location of your web site here, so that we may visit your site later and learn more about you. Also, we require your e-mail address so that we may send instructions online and can contact you via e-mail later.

Web Site Location (include the http://)
Site Name (In case we link back to you)
E-Mail Address:

Add me to the retailer mailing list.
This list will announce new items, specials, and other information that may be useful to our retailers.