Affiliate Sign Up - Kolimbo.com

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KowaBunga! The Original Since 1997!

Please fill out the information below. The contact information is used to allow easy signups to merchants in our network, and is not used for any other purpose.

Program Details

	Fields in Bold are required.
First Name:	*
Last Name:	*
Company:	*
Checks payable to?	*
Email:	*
Phone:	*
Address:	*
City:	*
State:	*
Zip:	*
Country:	*
Tax ID:	*
Password:	*
Confirm Password:	*

Website Details

URL 1:	*
What type of site?:	*
URL 2:
URL 3:
URL 4:
URL 5:

Additional Information

Choose Currency Used in Reporting at Kolimbo:
How do you plan on promoting Kolimbo merchants?
How did you hear about Kolimbo?
If applicable: the specific Forum / Program / SE:

Affiliate Agreement



*	I agree to the Kolimbo terms and conditions