NEW AFFILIATE REGISTRATION / INFORMATION / All Fields must contain information Enter NA for (Not Available)
* First Name:
* Last Name:
Enter Company Name / Personal Networking / Marketing / NA if not applicable:
* Address 1:
Address 2 :
*City:
* State/Province/Region :
* Zip/Postal Code:
*Country:
Date of birth:
Phone:
*Email:
*Confirm Email:
*Password:
*Confirm Password:
PAYMENT INFORMATION
*Enter NA if not applicable - Employer ID / Tax ID or SSN :
* Must Enter PayPal Account Email to receive One Lotus / Humicin Awards & Commissions Payments:

(We will send your commission payments to this PayPal account. )
WEBSITE INFORMATION
Enter NA if Not Applicable or Enter Web Site name:
Enter NA if not Applicable or Web site URL / Address :
Describe your marketing strategy i.e. introduce to friends & family, personal web site or special group... :
How do you plan to market our products? :
Word of Mouth
Friends & Family
Web site
Store Front
Personal network / Professional network
Commercial Website
Blogs and Online Media
Other
AFFILIATE PROGRAM AGREEMENT
I agree to be bound by the above Terms & Conditions