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Affiliate Signup Form
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First & Last Name
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Your E-Mail Address
a confirmation email will be sent to you at this address
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Choose a Username
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may only contain letters, numbers, and underscores
Phone Number
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Choose a Password
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Affiliate Payout Type
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Direct Deposit
Affiliate Direct Deposit - Account Type
Checking
Savings
Affiliate Direct Deposit - Routing Number
Affiliate Direct Deposit - Account Number
