Agami Media affiliate network - high-performance affiliate marketing solutions

Home

Publishers

Publisher Application Form

Limited Time Opportunity

Join the Agami Media Publisher Network, make $350 in the first 30 days
of your membership, and get a Gift from us! Read More.

Eligibility Requirements
Fields marked with * are required.


Contact Information
First Name *

Last Name *

Company Name

Phone Number *

Website Information
Primary Traffic Origin *

Through what channels are you going to promote our offers? * Use the Ctrl or Shift keys to select more than one channel.

Primary Website URL

Average Monthly Unique Site Visitors

Does your site offer incentives?

Category 1

Category 2

Secondary Website URL

Average Monthly Unique Site Visitors

Does your site offer incentives?

Category 1

Category 2

Add additional websites to this form (up to 5) [x].

Website 3

Website 4

Website 5

Website 6

Website 7

Email Publishers
Do you own or rent your email list? *

Where do subscribers join the list from? *

Is your email list single or double opt-in? *

How many names do you have in the list? *

Account Information
Email Address *

Password *

Confirm Password *

Payment Information
Send Payments To *

Country *

ZIP/Postal *

City *

Street Address *

State *

Tax ID / SSN *

State/Province

Province *

Payment Method *

PayPal Email Address *

Payment Threshold *

General Information
What do you think we should do to make your site more profitable?

What types of offers do you search for?

Do you have other comments or suggestions?

Where did you hear about Agami Media? *

Specify *


I confirm that I have read and agree to the terms of Agami Media Publisher Agreement. *