Affiliate registration form

Title	- Please Choose - Mr Mrs Miss Ms Dr Prof Other
First name
Last name
Email address	(please check your spelling)
Full address
Type of affiliation you would like	I'd like a complete web site similar to this one I'd like to add your price comparison tables to my own site I'd like to use your datafeed and develop my own comparison software
Which domain name would you like?	http://www. (if using your own site)
Do you have any other web sites?	No Yes, I have
Please choose a user ID	(for accessing your sales reports)
Please choose a password
Please confirm your password	(re-type the same password in this box)
Do you have any questions?

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