Affiliate Program Enrollment

Affiliate Program Enrollment Form

Name

First

Last

Phone Number

Address

Are You A Current Client

If Yes What Is Your Show Title or Contract Number

Payment Preference

If PayPal or an App What Handle/EMail Do We Send It To

If a Check - What Address and Name Should We Send It To

Do You Want Your Balance Applied To Your Contract/Agreement

This is optional, if you say yes, we will retain any balance and send the rest, unless there is still a balanced owed to us. You may change your mind at any time. If you are behind we will take the amount out first by default

Digital Signature

Full Name

Send Address Is

Agreement

I Agree

By clicking above I agree to the terms and conditions. I validate that all information is true to the best of my ability. I agree that if something changes I will contact AMFM247 Media by email or mail to notify us of the changes, as AMFM247 Media is not responsible for lost money due inaccurate information on file.

Affiliate Program Enrollment Form

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