Application form to create an affiliate account with Lavendar's Latex Lair. 

You do not need any official forms showing you are a registered business, but we will need your Federal Tax ID number if you are a business or your Social Security number if you are an individual for tax reporting.

As an individual, you will be an independent contractor and gross revenues paid to you over $600 must be reported to the Federal Government. We will send you a 1099 form with reported earnings over $600 at the end of each fiscal year. If you do not earn $600 or more, no report is made to the IRS.  

Please fill in all the applicable information. Once your information is validated you will be sent a user ID and URL string. Only orders placed from your affiliate URL will get credited.

Please provide the following contact information:

      First Name	 
       Last Name 	 
  Middle Initial 	 
Business or Individual   
    Company Name	      
  Street Address	 
 Address (cont.)	 
            City	 
  State/Province	 
 Zip/Postal Code 	 
         Country 	 
      Work Phone  	 
      Home Phone	 
             FAX	 
          E-mail	 
             URL

Please provide the name you want as the legal payee on your commission checks:

  Payee Name	        

	Tax ID # (If paid to a business) 
    Social Security # (If paid to an individual)