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Partner, Manager, and Sales Representative Agreement

Advertisers signing up for the first time should also start here. Be sure to click on  the advertiser box at the bottom of the form.

I have read the terms and conditions, including privacy policies of Activity Web and agree to those terms, conditions, and policies, as amended. I understand that my monthly commissions will be sent to me via PayPal^®.

First Name:
Last Name:
Organization:
For Profit Not-For-Profit  (if you choose Not-For-Profit, and we find this is not true, your account may be cancelled without warning and with no refund!)
Address1:
Address2:
City:
State:		<select> Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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 Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip or Postal Code:
If Outside US, Provide Remainder of Address:
Phone:
Fax:
Email:
Re-enter Email:
Tax ID or SS#:
Mother's Maiden Name:
I wish to be an Activity Web Partner. There is no charge to me for this.
I wish to be an Activity Web Manager. There is no charge to me for this.
I wish to be an Activity Web Sales Representative. There is no charge to me for this.
I wish to become an Activity Web Advertiser.