Abundant Earth
Affiliate Rewards Program Application

Your name:
Email address:
Personal and Company Information You may also fax this form to us at (360) 385-2196 (We are only accepting U.S. Affiliates at this time). Company Name: Address:  City:    State: Zip:    Home Phone:  Work Phone:   Fax: E-mail: Web Site URL (where links will be posted): Name of Web Site: Billing Information: For tax reporting purposes, we need either a Social Security Number or a Federal Employment Identification Number: Would you like us to send your referral fee checks to the address above:     Yes     No        If "No," please fill in the name address of check recipient in the box provided: Additional Web Site & Store Information: Please select the box that best describes your web site:  Personal Site    For-Profit Business Site     Non-Profit Organization     Food Cooperative     Other:  Approximately, how much traffic does your web site generate each month? (Please indicate whether these figure represent "hits," "page-views," or "individual URLs."  Hits     Page-Views     Individual URLs   Choose One Less than 500 501 to 1500 1501 to 5000 5001 to 10,000 10,001 to 50,000 50,001 to 100,000 100,001 + This time, please choose the box that best describes the overall theme of your web site or store:  Environmental     Health or Spiritual     Children or Family  Community, Cultural, or Ethnic     Other: In your own words, briefly tell us why you are interested in affiliating with Abundant Earth: Abundant Earth, LLC 762 West Park Avenue Port Townsend, WA 98368 Phone (360) 385-2262    Fax (360) 385-2196 Any additional comments? By pressing the "SUBMIT" button below, you indicate that you have read, understand and agree to the terms provided in the Abundant Earth Affiliate Rewards Program Contract, and if Abundant Earth, LLC accepts this application, you agree to be bound by the terms and conditions of the Abundant Earth Affiliate Rewards Program Contract