Affiliate Payee Information Form

Payee Name: ___________________________________

Enter the name exactly as it should appear on the check.

Preferred Payment Method (PayPal or Check): _________

If PayPal, PayPal Email Address: ____________________

Address Line 1: __________________________________

Address Line 2: __________________________________

City: __________________________________________

State, Province or Region: ________________________

ZIP or Postal Code: ______________________________

Country: ______________________________________

Phone Number: _________________________________

Primary Email Address: ___________________________

Is Primary Contact same as Payee? (circle one) Yes / No

If No, Contact Name: _________________________

Contact Email: ______________________________

Contact Phone Number: ______________________

Your Website Profile:

What is the URL of your primary Website?:

_____________________________________________

What is your primary method of generating referrals to SellMoreNow.com?:

_____________________________________________

_____________________________________________

Your Payee Tax Information

Tax Name: ___________________________________

Required for U.S. citizens, residents and corporations.

Tax ID Number: _______________________________

Payee Tax Information (for U.S. citizens or residents).
U.S. Social Security number (for individuals) or
U.S. tax ID (for corporations).

Tax Country (circle one): USA / Other: ______________

Organization Type (circle one): Individual / Corporation
Partnership / Other

By my signature below, I certify that to the best of my knowledge the statements herein are true, complete and accurate. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal or civil penalties.

I ACCEPT EXCLUSIVE LIABILITY FOR ALL PAYROLL TAXES AND CONTRIBUTIONS IMPOSED BY FEDERAL OR STATE LAWS.

Name (print): _________________________________

Title (print): __________________________________

Signature: ____________________________________

Date: ________________________________________

Please mail completed and signed pages to:

Rich Bohn
Sell More Now Inc.
322 East Main Street, Suite 322
Burley, ID  83318-1933