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SellMoreNow.com 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
