Form

First Name: *
Last Name: *
Company Name:
Address 1: *
Address 2:
City: *
State/Province: *
Zip/Postal Code: *
Country:
Phone Number: *
Prime Email: *
Please double check your email address in the above field, as this is where we will be sending your all of your start-up information once we approve your application.
Tax ID (US Citizens):
Please Answer The Following Questions:
Website URLs:

Were you referred by an existing LWLMedia Partner?	Yes No

If "yes", Who?
Tell us about your Internet marketing experience. This will help us tailor our information to your needs.	I don’t have a domain name yet I have a domain name but no web site I have a web site but haven’t made any money online yet I have a web site and I’m currently making money online I have a web site and an e-mail list and make money online

If you have an existing opt-in e-mail list or newsletter, how many subscribers do you have?	Under 1,000 1,001 – 5,000 5001 - 10,000 10,001 - 25,000 25,001 - 50,000 50,000+

Which of the following affiliate products are you interested in promoting first?	MastersofTheSecret.com LWLCoaching.com ProfitWithInterviews.com RenegadeGrowthPak.com RenegadeMoneyGuide.com 16SuccessExperts.com Not Sure Possibly All Listed

How do you plan to initially promote our products?

Any comments or questions for us?


Please review the Operating Agreement, which describes the terms and conditions of your participation in the LWL Affiliate Program. Once you have filled out this form and reviewed the agreement, press the "Submit Application" button to submit your application. If your application to participate in The LWL Affiliate Program is accepted, you hereby agree to be bound by the terms and conditions of the operating agreement which you hereby state to have read and understood. It is against your partners agreement to advertise any LWLMedia managed website or product via unsolicited email. DO NOT send unsolicited email to promote any of our products or you will be in violation of your partner's operating agreement and your account will be terminated, forfeiting all outstanding referral fees. Your cooperation and understanding is appreciated.