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Welcome to the Extreme Restraints Affiliate Program Registration

If you already have an affiliate account, please log in using the login button at the top of your screen. This page is for creating a new affiliate account only.

Create your store account:

   
 
Your Personal Details * Required information
Affiliate Code:  * (This will be your login and affiliate ID)
First Name:  *
Last Name:  *
E-Mail Address:  *
Company Name:
Tax ID:  * (U.S. residents use your SSN or TID,
                                            non U.S. residents please use "NA")
Make Checks Payable to:  *
 
Your Address
Street Address:  *
Zip Code  *
City:  *
State:  *
Country  *
 
Your Contact Information
Phone Number
Fax Number:
 
Your Password
Password:  *
Password Confirmation:  *
 
I Agree to the Terms & Conditions: * Yes
 
 
 



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