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First Name*

Last Name*

Email*

Legal Eternity Type (Company Or Individual/Sole Proprietor), If Company Provide Your Company Name*

Street Address*

Street Address 2

City*

Zip/Postal Code*

Country*

Phone Number (With Country Code)*

Your Skype Id?*

Your Social Profiles (Facebook/LinkedIn/Twitter/Etc.)*

Which verticals do you work with?*

Apps Auto Biz Opp Business CBD Cash On Delivery Crypto/Forex Dating/Relationship Debt Downloads/Extensions Education Email Submits Entertainment Financial Free Stuff Games Health/Beauty/Fitness Home Jobs Legal Nutra Real Estate Services Shopping Smartlink Solar Surveys Sweepstakes VOD VPN eCommerce Insurance Utilities Survival Donation Background Check Personal Development Spirituality Credit Score Travel Other

What payment models do you work with?*

CPA CPC CPM CPI CPL CPS RevShare

What are your traffic sources?*

Email (Solo Email, Newsletter) Contextual (Pop Overs/Unders, In Text Ads) Display (GDN/Banner Images/Banner Ads) Social (Facebook, Instagram, Twitter, LinkedIn, SnapChat, Etc) Search (Bing, Google, Yahoo, Etc) Incentive (Points, Rewards, Etc) Native (Ads Integrated In To Content) Mobile Ads (In App, Push Notifications)

Where does your traffic come from?*

North America (US, Canada, etc.) Europe (UK, France, Italy, Germany, etc.) Asia (Singapore, Japan, India, South Korea, etc.) Oceania (Australia, New Zealand, etc.) South America (Brazil, Paraguay, Argentina, Peru, etc.) Arab (Qatar, UAE, Kuwait, etc.) Africa (South Africa, Egypt, Nigeria, etc.)

How are you planning to promote our offers? (Describe your advertising methods)*

Do you use an incentive to promote your campaigns in any way? Ex. Facebook rewards, Cash, Points:*

How long have you been doing Affiliate Marketing?*

What types of offers have you had the most success with in the past? (Offer Names & Verticals)*

Are you looking for specific offer or campaigns from our network? if yes, include offer names*

How much do you currently spend per month on affiliate advertising?*

How much affiliate revenue do you currently generate per month?*

Are you active on any Affiliate Marketing forums or online discussion boards? (If Yes, Name Of Forums/Discussion Boards With Your Username)*

So That We Might Better Assess Your Profile, Please Provide Screenshots Of Your Income With Other Partners.*

Please Provide 2 References From The Networks Mentioned Above ( Name + Email Address )*

Payout Method*

Billing Frequency*

Tax ID / VAT or SSN

When joining a new network, what aspect of the business relationship is most important to you?*

Please explain why you are applying to our network. (why you choose us)*

Tell us why you think you will qualify.*

What is the best way to contact you? (Email, phone, or IM)*

How did you hear about us? (Please be specific. If it was a forum/blog or website, which one was it?)*

Ambalayaaffiliate maintains a zero-tolerance for identity fraud. Do you agree with the following? I agree that all information I have provided regarding my identity, address, country of residence, business name (if applicable) is truthful and valid.*

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I understand that sending fraudulent traffic will result in the termination of my account and loss of all commissions.*

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I agree to receive email news latter's from Ambalaya Affiliate Network.*

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