PluginLeads.com

APPLY

No free domains allowed. You need to own a support@yoursitedomain.com email address to be able to become our affiliate.

All fields are required!

Full name:
Company:
Street address:
City:
State:
Zip / postal code:
Country:
Email address:
Confirm email:
Phone #:
Website URL:
Approximate number of monthly visitors:
Overall number of members:
Members registered in the past 3 months:
Preferred payment option:	(Payments are either every 7 days by e-gold or every 2 weeks by wire)
Please state the amounts you want to pay your members for every type of offers:	$0.10 offers: $ (recommended $0.05) $0.20 offers: $ (recommended $0.10) $0.30 offers: $ (recommended $0.15) $0.40 offers: $ (recommended $0.20)
Please state the amount you want to fine your members by for every false completion of an offer:	$ (required minimum $0.50)
Desired login name:
Password:
Retype password:
Referred by: