Confimax.com / Affiliates / Signup

Signing up as a Confimax Affiliate is simple:

1. Enter Account Information

Fill out the following form, then click NEXT.
Fields marked with an asterisk (*) are required information.

*Username:**
	Choose a username to use to login to your Affiliate account at Confimax (3-16 characters, no spaces)
*Password:**
	Choose a password for your account (4-16 characters)
*Reenter:**

*Name:**
*Email:**
*Web Site:**
	Enter complete url: (http://www.mysite.com)
Company:
*Address:**
Address:
*City:**
State/Province:
*Zip/Postal:**
*Country:**
Time Zone:
Phone:
Fax: