Affiliate Application

By filling out and submitting this form you are applying to be an ETSZeolite.com affiliate. Upon submission of this form, a 24-hour-per-day, order-taking, replicated web site will be activated for you.

Affiliate Prefix:

Back Office Password:
Minimum of 5 characters

First Name:

Last Name:

Email Address:

Day Phone:

Evening Phone:

Payee Name:

Payee Address Line 1:

Payee Address Line 2:

Payee Address Line 3:

Country:

City:

State or Province:

Postal Code:

Paypal Address:

Web Site Phone Number:

Web Site Toll Free Phone Number:

Tax ID:

Clicking Submit indicates that you have read and agree to all the terms outlined in the Affiliate Agreement. Please enter your initials to indicate that you are digitally signing this agreement.

IP Address:

38.107.191.99

Affiliate Prefix: This is what identifies YOUR replicated ETSZeolite.com and ensures that you get credit for sales coming through your web site. Example: xyz.ETSZeolite.com. If the affiliate prefix you enter has already been taken, you will have to choose a different prefix.

First and Last Name, Email Address, Day Phone, Evening Phone: Communications about your affiliate account will be made to this person at the email address you enter, and possibly to your phone numbers.

Payee Name and Address: Commissions are sent via check to this person or organization.

Paypal Address: If you enter a Paypal address, commissions will be sent through Paypal (you will lose a small percentage of your commission to Paypal).

Web Site Phone Number and Toll Free Number: These phone numbers will appear on the Contact Us page of the webs site. Putting your numbers here means that you will be responsible for answering sales/customer service phone calls.

U.S. Tax ID: if you are subject to U.S. tax laws, then you must provide a TAX ID number. Click here for more info.

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The information on this website is not intended to replace a one-on-one relationship with a qualified health care
professional and is not intended as medical advice. It is intended as a sharing of knowledge from the
research and experience of the ETSZeolite staff and contributors. You should not use the
information on this site for diagnosis or treatment of any health problem
or for prescription of any medication or treatment. You should
consult with a healthcare professional before starting
any diet, exercise, regimen or supplementation
program, before taking any medication, or
if you suspect you have a health problem.
You should not stop taking medication
without first consulting with your
physician or health professional.

* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. If you are pregnant, nursing, taking medication, or have a medical condition, consult your physician before using this product.