Name (required)

Last Name (required)

Username (required)

Account Email (required)

Tax ID / SSN# / EIN# (required)

Full Name* (as shown on bank account – required for ACH payments) (required)

Payment Information (We pay our affiliates electronically using ACH. Please provide your banking information in the correct spaces provided below)

Routing number* (required)

Confirm Routing number* (required)

Bank account number* (required)

Confirm Bank account number* (required)

Financial institution* (required)

Website URL

How will you promote us? (required)

Who referred you? (required)

BY CHECKING THIS BOX, I AGREE TO THE IW (1) TERMS OF USE, (2) AFFILIATE AGREEMENT, (3) INDEPENDENT CONTRACTOR AGREEMENT (required)