Affiliate Online Registration Form - Step 1 of 3

Choose Username and Password

User Name:	(20 chars max - alpha numeric only)
Password:

Account Information

Company Name:
Your Name (first, last):
E-mail:
Address:
Apt/Suite #:
City:
Country:	Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Côte d'Ivoire CD Congo Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (North) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway null Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Saudi Arabia São Tomé and Príncipe Senegal Serbia Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States minor outlying islands Uruguay USSR (former) Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands Virgin Islands Wallis and Futuna Western Sahara Yemen Yugoslavia (former) Zambia Zimbabwe
State:	Choose State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Province:	Choose Your Province Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Region:
ZIP/Postal Code:
Phone Number:	- -
Fax Number:	- -
Checks payable to:	Me Personally My Company

Questionnaire

Please take some time to answer the questions below, it helps us improve our techniques, create better benefits for our affiliates and also provides fresh feedback.

1) I joined Commission River to	Earn extra money Enable me to make money by working at home Add to my current online marketing
2) I would like to earn	$100 per month $500 per month $1000 + per month
3) I like the product assortment. My interests are in selling
4) I could be even more successful if on Riveroffers.com we offered
5) I currently	Operate my own website(s) Do not have a website of my own Do not know how to build a website
6) I have sales experience in the following field(s):
7) My level of online sales experience is	Experienced Some experience No experience
8) The tools I would most need are	Training Offline materials Online tools, XML plug ins, etc.

Terms and Security Code

I agree to Commission River Terms and Conditions
Security Code:	(Enter the red number below)