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After submitting this form, you will receive a PDF of a contract as an attachment to a return email.

You MUST complete and sign this contract and fax it back to us.  Our Toll Free Fax number is printed on the contract.

* ALL fields marked with a red * asterisk are required.

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How Did You Hear About Our Program?*


 If you were referred by a friend, what is their name or MyBizWebs ID?


 Your Full Name*


 Your Mailing Address*


 Your City, State or Province & Postal Code*


Your Country*


 Your Phone Number & Best Time(s) To Call*


 Your Email Address*


 Your Email Address Again, Please*


I Am Completing This Form For ...*


 Please Upload A Photo For Your Web page or Web site and/or Print Media


Note:  The lite and professional affiliate programs include printed business cards and rack cards.  If you are signing up as a free affiliate, you may order 50, 100 or 250 business cards and rack cards for a small fee.  This is OPTIONAL.  See below.

  • 50 business cards & 50 rack cards for $15
  • 100 business cards & 50 rack cards for $20
  • 250 business cards & 50 rack cards for $25

Please indicate in the Questions or Comments box you would would like to add business cards and rack cards to your affiliate program.



 Questions or Comments?


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