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Affiliate Program Application
Before finalizing and submitting your application, please review the Operating Agreement, which describes the terms and conditions of your participation in the CompuBank Affiliate Program. Once you have reviewed the agreement and filled out this form, press the YES button to submit your application.
Contact Information
Contact Name:

Company Name:

 		Payee Information
Check here if same as contact

Payee Name:
Address Line 1: (USA Only)

Address Line 2:

City:

State:

Zip Code:

Phone Number:
 
Fax Number:
 
Email Address:

 Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Phone Number:
 
Fax Number:
 
E-mail Address:

Check here for monthly direct payment to your CompuBank account. Otherwise payments will be quarterly by check. Your Tax ID is required.

Tax ID: REQUIRED
This is either your social security number or employer identification number. Please do not enter dashes between numbers (example: 123456789)

IMPORTANT! Make sure you use the same identification number for your account application.

Describe your Web site: How do you categorize your Web site?

Name of Web site:

URL of Web site:

How Did Your Hear About CompuBank?


By pressing the YES button below, you indicate that you want to apply to participate in the CompuBank Affiliate Program, that you have reviewed the Affiliate Operating Agreement and understand its contents, and that, if CompuBank accepts this application, you agree to be bound by the terms and conditions of the Operating Agreement. In addition, you certify that your Web site does not contain objectionable content as described in section 1 of the Operating Agreement.