Home > A Back and Neck Support Store
Affiliates Program
Submit your application
Before finalizing and submitting your application, please review the Affiliates Agreement, which describes the terms and conditions of your participation in the Affiliates Program. Once you have filled out this form and reviewed the agreement, press the "Yes" button to submit your application or the "No" button to exit.
Payee Information
Please fill out the name and address of the person or company to whom we should make checks payable. Please note that we can only accept one payee name in the box below.
Payee's name: (Please enter ONLY the name of the person or entity to whom the check should be written) Address Line 1: (Enter 'care of' or 'attention' for the name of the person to whom the check should be sent here) Address Line 2: City: State: ZIP Code: Phone number: Payee's e-mail address:
Contact Information
Please enter the name and address of the person to whom we should address all correspondence about your participation in the Affiliates Program.
Contact person's name: Address Line 1: Address Line 2: City: State: ZIP Code: Phone number: Contact person's e-mail address:
Enter the name and URL of the Web site through which you wish to link to The-Backstore.com.
Name of your Web site: Home page URL of your Web site:
Add any other brief comments or questions below:
Description and comments:
How did you learn about the Vitalityweb Affiliates Program? Select One: -- Web Banner Ad Newspaper/Magazine Ad News Article Vitalityweb.com Associate Visit to Vitalityweb.com Mail Word of Mouth Other