Newsletter Signup
 

Affiliate Sign Up Form

Affiliate Account:

Affiliate Company Name
Affiliate Website
Affiliate will promote Jenica Media Services, Inc. using the following methods
 Links from Website
 Email Newsletters (Opt In Opt Out)
 Point of Sale
 Personal Sales
Other

Affiliate Contact Information:

Contact Name
Contact Email
Contact Address
City
State
Zip
Contact Telephone
Make checks payable to
Tax ID/SS #
By checking this box I have read and understand the Jenica Media Services, Inc. Affiliate Terms and Condistions.

Affiliate Terms and Conditions