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Complete the following form if you are interested in generating revenue for your site by hosting banners from the SAFE Market. Pornographic and illegal software sites are not accepted (click here).

Your Details
Contact Person
Payee Name
! The Payee Name should be the name you want all checks to be made payable to. Note that there may be a surcharge for re-issuing a check if the wrong name is registered in the first place.
Street Address
City
State/Province
Country
Zip/Postcode
Telephone
Fax
E-mail
URL
In which currency would you like to be paid?

Site Information

Please describe the nature of your site (no more than 250 characters)
Choose the option or enter a value that approximates access to your site/product the best
  • Visits per week
  • Interest Profile
    and/or
    and/or
    Please describe the people that access your site (no more than 250 characters)

    Please tell us how you found out about this site (If a search engine describe which and the keyword you searched on)
    SAFE Promotion Code: (leave blank if not applicable)

    SAFE User Information

    Preferred Login Name:
    Password:
    Confirm Password: