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New Publisher Criteria:
Before you apply please review the following requirements:

All publishers are subject to approval
You must own and operate the site with which you apply
The site must be live, functional, and regularly updated
The site and audience must be relevant to our B2B offers
The site cannot feature adult content
Read all RevResponse Terms and Conditions

New Publisher Application (all fields required)

Your Account

Email *	Username * Note: Your username will be visible to the RevResponse community
Website URL * Should be in the fully qualified URL format. Example: http://www.yourwebsite.com

Contact Information

First Name *	Last Name *	Phone *
Secondary Email	Instant Message Name	IM Provider
Job Title	Company
Address1 *	Address2	Country *
City *	State	Postal Code *

W9 Information (*Required for US citizens only)

PLEASE NOTE:
Publishers residing in the United States are required to submit W9 information. To make updates to this information in the future publishers are required to contact their Account Manager.

Name (as shown on your income tax return)*

Business Name (if different)*

Choose to have checks made payable to either the Name or Business Name entered above:*

Name

Business Name

Tax Classification*

Tax Class - Other

Enter your Taxpayer Identification Number (TIN) in the appropriate box. The TIN provided must match the name given in the Name field to avoid backup withholding. For individuals, this is your social security number (SSN). For other entities, it is your employer identification number (EIN).For more details, click here.
Social Security Number / Employer Identification number*
Check here if the contact address listed above is the same as the address on your tax return
Address1*	Address2
City*	State*	Postal Code*
Under penalties of perjury, I certify that:
The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
I am a U.S. citizen or other U.S. person (defined here).
Certification Instructions: You must contact your account manager if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. See the instructions here.

Payment Information

Report Information

Check the progress reports you wish to receive by email. To include additional members of your team on the report distribution list, please insert the email addresses below.

Additional Email Distribution List

Daily Activity Report

Weekly Activity Report

Monthly Activity Report

I agree to the terms and conditions of NetLine Corporation's RevResponse Publisher Program Agreement.

PLEASE NOTE:
1. You are responsible for the details entered here. Please protect your username, password, and access to your account.
2. Once a publisher is approved, the publisher is responsible for entering full payment information in "My Account" before payments can be processed.

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