Affiliate Application

Contact Information

*First Name:
*Last Name:
*E-mail Address:
IMPORTANT - Password must contain at least 8 characters and include a number and both a lower case and an upper case letter.
*Verify Password:
*Phone Number:
Fax Number:

Company Information

*Type of Business:
*Business Description:
*State: Province:
*Postal Code:

Payment Notification Email

*Tax ID/VAT or SSN:
*Make Payment To:
*Payment Type:
*Payment Email:
PayQuicker simplifies the online payment process and provides a secure and easy way to receive money

Website Information

*Website URL:


How did you hear about us?

By clicking the SUBMIT APPLICATION below, you expressly agree to the Terms of Use and Affiliate Agreement.