Insurance Affiliates

$12* PER LEAD
PAID MONTHLY!

Insurance Affiliates Application
NOTE: FORM DE-ACTIVATED DUE TO SPAMMERS

Please fill out the name and address of the person in charge of the sponsoring website. This is the person to whom we will address all correspondence about your participation in the Insurance Affiliates Program, and to whom we will mail your commission checks.

Company Name:
First Name:*
Last Name:*
Address:*
Address2:
City:*
State or Province:*
Postal:*
Country:*
Phone:*
Email:*
	Please double check your email address in the above field, as this is where we will be sending you all of your information.

Tax ID:*	(Indicate type on next line.)*
	My Social Security Number Employer Identification Number
Website URL:*
Website Title:*
Website Traffic:*	estimated visitors per day

Describe Website and source of referrals:*
*Required Fields
Please review the Operating Agreement which describes the terms and conditions of your participation in the Insurance Affiliates Program. Once you have filled out this form and reviewed the agreement, press the "Submit" button to submit your application. If your application to participate in the Insurance Affiliates 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 affiliate agreement to submit bogus leads, or to advertise our Life Insurance Website via unsolicated email. DO NOT submit bogus leads or send unsolicited email to promote our site, or you will be in violation of your affiliate's operating agreement and your account will be terminated, forfeiting all outstanding referral fees. Your cooperation and understanding are appreciated.

Thank you for your interest in our Insurance Affiliates program!

If you experience any problems, please email affiliates@insurance-affiliates.com

AGENTS
Get your own Quote Engine!

Agents can use our quote engine for licensed states.
We will still pay you $12 for leads from other states.

Link to our site, and we'll manage an affiliate program for you! Here are some sites that are now using this:

buy term
accurate rates
term insurance
term life insurance
life insurance

Sign up now!

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