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Publisher Application
General Information
Site Name:
URL:
Password:
Daily Traffic: (page impressions per day)
Referred By: Enter numeric ID of publisher.
(leave blank if you were not referred by an existing publisher)
Contacts
Sales Contact:
Email:
Phone:
Fax:
 
Traffic Contact: Same as Sales
Email:
Phone:
 
Targeting
Category:
Geo-Targeting: Check here if you can geo-target.
This applies if the users of your site are primarily from a defined geographic region, or you can target based on user entered criteria.
Zip code for geo-target  Miles from
(if target area is limited)
Where payments are sent
Important: This is exactly what prints on your payment check.
Name:
Street:
City:
State:
Zip:
Country:
Tax Id.: (if individual use SS#)
I have read and agree to the publisher Terms.
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