Affiliate Program Application

Signing up for our Affiliate Program is quick and easy. Within five minutes of completing this form, we'll send your username and password to access the Affiliate Resource Center. Simply fill out this form with the name and mailing address of the person to whom we should send marketing fees earned through this program. (This information is automatically imported into our database; the name you provide here will appear on your monthly marketing fee check.) Please provide the following information: Note: You must enter a password and admin. contact with email address to protect your account and so we can contact you if required. Company Name: First Name: Last Name: Street Address: City: State/Province: Postal Code: Country: United States Phone: Fax: Email: Confirm Email: Please double check your email address in the above field, as this is where we will be sending you all of your information. Tax ID: Password : Password (confirm): Website URL: Website Title: Website Description: Please review the Operating Agreement, which describes the terms and conditions of your participation in our Affiliate Program. Once you have filled out this form and reviewed the agreement, press the "Submit" button to submit your application. If your application to participate in Gerson & Company, Inc's. Affiliate Program is accepted, you hereby agree to be bound by the terms and conditions of the operating agreement which you hereby state to have read and understood. It is against your agreement to advertise Gerson & Company, Inc. via unsolicated email. Some people think that affiliate's "spam" email originated from us, damaging our reputation and causing us many administrative problems. DO NOT send unsolicited email to promote Gerson & Company, or you will be in violation of the operating agreement and your account will be terminated, forfeiting all outstanding referral fees and subject to legal action. Your cooperation and understanding is appreciated.     You will be contacted by email within 5 minutes with your password and easy instructions to get set up immediately. Copyright 2004, Gerson & Company, Inc. All Rights Reserved