Affiliate Application

Site Name:

URL of page where link will be:

Name: {First MI Last, suffix}

Title:

Phone:

Fax: -

E-Mail:

Pay To Name:

Address 1:

Address 2:

City:

State: -- Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Offshore Ohio Oklahoma Oregon Out of Country Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Zip Code:

Country:

Please enter a username for your account:

Please enter a password for your account:

Confirm Password:

This section will help us determine where you will be placed in our Smart Loan Advertising Network. Please fill out these questions to the best of your ability

What is the categorical classification of your web site? (Pick one):

Outdoors

What is your business tax classification?: Individual Corporation

What is your Social Security Number (individual) or Federal Tax ID (corporation)?:

How did you hear about our affiliate program?: Received an email from Excel Credit Received an email from another Affiliate/friend Saw Excel Credit Affiliate program on another site Visited Excel Credit web site Press release or new article Other

By pressing the 'Apply' button, you agree that you are applying to become an Excel Credit loan affiliate, that you have reviewed the Affiliate Agreement that can be found here and understand its contents, and that, if Excel Credit accepts this application, you agree to be bound by the terms and conditions of the Affiliate Agreement.