To become a Broqueville.com affiliate and begin collecting 10% of all sales generated by you, please fill out the form below and hit the submit button. You will be contacted via email with instructions and a confirmation of your affiliate referral name. (You do not need a website to become an affiliate. You can be an affiliate by word of mouth and email.)

You must fill this form out completely or we will not be able to open your affiliate account!

First Name:
Last Name:
Website Name:
(optional)
Company:
Title:
   
The address where we may send you your monthly checks:
Address:
City:
State: Zip:
Telephone:
FAX:
E-mail:
   
  Charities who wish to use our products as fundraisers please fill in the blank below to receive 50% of all e-book and e-course sales and 10% of all soft cover book sales.
Name of Charity:
(if applicable)
 
Choose a name (you may use your own) and type it below, this name will give you 10% of the purchase price. Tell your referrals to mention the name for a discount on purchases. Choose two other names in the event that your first choice has been selected already.
 
Primary Name Choice:
Backup Name 1:
Backup Name 2:
 
We will email you with:
  1. The link and the html that you may put on your website. (optional - you do not need a website to become an affiliate)
  2. An email address with a sample excerpt from three of our books and four of our courses that you may send to your recipient list.
  3. Verification of your code word.
   

 

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Copyright© 2003
Paulette Renee Broqueville