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dotcanuck Affiliate Program - Sign Up

Use this form to sign up for the dotcanuck Affiliate Program. Click for program details.

Affiliate Name (This field used in the HTML code to replace "YOURNAME". It may be an individual, corporation or other legal entity. This is the name which cheques are made out to.):

Contact Name (if different from Affiliate Name):

Mailing Address:


Province / State:

Postal Code / ZIP Code:

Contact Email Address:

Telephone Number:

Fax Number:

GST Number (Company) or Social Insurance Number (Individual):

Website Addresses (where banners will be placed):

Check to indicate that you have read the Affiliate Program Agreement.