| Additional Information |
Current Occupation:
We do not divulge your personal information. This is for statistical purposes only. We apologise some information below is required to be entered again for office purposes
|
|
|
Email Address:
This email address will be used for confirmation of joining and will be used for all admin emails. We will not spam your email box nor sell or trade your email address
|
|
|
|
Title:
|
|
|
Full Name:
Full Name
|
|
|
Birthdate:
Date of Birth
|
|
|
Gender:
Male or Female
|
|
|
Street Rd/Number:
Street/Rd Number
|
|
|
Street/Rd Name:
Street/Rd Name
|
|
|
Suburb/Area:
Suburb/Area
|
|
|
City:
City
|
|
|
Post Code:
Post Code
|
|
|
State:
State
|
|
|
|
Island or Other:
|
|
|
Country:
Country
|
|
|
Website Partner:
The name of the website you are partnering with
|
|
|
|
|
Identification Type:
Valid form of ID: Drivers License Number, Passport Number, Social ID or Birth Certificate ID - You will be asked to email us the ID you use, to prove who you are.
|
|
|
Identification Record Number:
The Officially Recorded Number of the ID that you are submitting
|
|
|
Domain Name - Take Care With Spelling:
This is the domain name you chose from our list of allowable domain names to participate in our partnership program at http://word-presswebsite.com/home-based/ We take no responsibility for any spelling errors you make
|
|
|
I Authorize You To (Print Your Full Name):
Utilize this domain name for my partnership website as part of the word-presswebsite.com partnership program
|
|
|
I Agree (Print Your Full Name):
Under the partnership program I will have the use of this domain but not own the intellectual property rights to it. We acknowledge it may constitute part of the goodwill if you sell your business and are happy for you to benefit from that component of it
|
|
|
I Agree (Print Your Full Name):
To pay the full cost required for word-presswebsite.com's partnership program to re-register this domain, once a year when due, in order to retain the presence of my partnership website online on the world wide web
|
|
|
How Much Do You Wish To Earn?:
The amount you expect to earn from your website after 3 - 6 mths
|
$10 - $50 p.w
$51 - $100 p.w
$101 - $250 p.w
$251 - $500 p.w
$501 - $1,000 p.w
$1,001 - $2,000 p.w
$2,001 - $5,000 p.w
$5,001 - $10,000 p.w
$10,001 - $20,000 p.w
$20,001 + p.w
|
|
|
How Many Hours Can You Invest?:
Note: With investment you can work virtually no hours - for this area tell us the hours you expect to work without capital investment. If you plan on investing $ in your website choose 0-1 hrs p.w
|
|
|
|
Will you be investing capital in advertising your business?:
|
|
|
How much do you expect you will invest?:
General figure
|
|
|
I Agree (Print Your Full Name):
To market my website fairly to all concerned in a responsible manner and within the rules and regulations of https://www.icann.org/ and agree not to spam nor harass anyone
|
|
|
Declaration: I hereby declare that I am of sound and stable mind to conduct business and am not currently held within, nor currently under a service or notice of intent to serve within, any penal institution, mental hospital nor prison:
Includes any other institutuion that is operated by any government where you are a ward of the state
|
|
|
Declaration: I declare these details to be true and correct and that I am at least 18 years of age at the time of submitting this form:
Print your full name in the box
|
|
|
Comments / Suggestions:
Add any comments or suggestions you may have to improve our service
|
|
|
