Web Publisher Programme Application

Saturday, November 22, 2008

Join the web publisher programme

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Web Publisher Programme Application

Before completing your application, please read the Operating Agreement, this describes the terms and agreements of your participation in the Affiliate Programme. If you agree to these terms and conditions, please tick the box and continue to fill out the form below.
Payee Information
Please fill out the details of the person/company who is to be paid referral fees earned through this programme.
Payee's email address:

Payee's name:

Payee's address:

Payee's postcode:

Payee's Country:

Payee's telephone number:

Contact Information
If the Payee and Contact details are the same, please tick this box, and continue below.
Contact email address:

Contact name:

Contact address:

Contact postcode:

Contact Country:

Contact telephone number:

VAT
Are you registered for VAT?
Yes, my VAT number is:
No.
Payment Information
Referral fees can be paid by cheque, or by bank transfer directly into your account, in this case notification of payment will be sent by post. Please select one of the following:
Pay me via bank or building society account
Pay me by cheque
If payment by bank or building society selected, please complete this section otherwise continue below.
Bank or Building Society Name:

Account Number:

Sort Code:
(Digits only, no dashes)

Your Website Information

What is the name of your website?

What is the address of your website?

What category does your site best fit into?

How did you find out about the Affiliate Programme?

Finally

Remember you on this computer?
If this is not a public computer and you trust any other people that use it (e.g. family) then keep this box ticked, otherwise un-tick it.

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By clicking on the 'Submit' button below, you understand that you are sending your application to extura.com to join the Affiliate Programme, and that you have read and agree to the terms and conditions of the Operating Agreement. If you disagree with the terms and conditions, then click here to be returned to the extura Homepage.