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SMC Revenue Affiliate Signup

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Contact Information
E-mail:		Verify E-mail:
ICQ:		AIM:
Mailing Address
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Address:		Address (cont):
City:		State:
Zip Code:		Country:
Payment Details
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Pay To:		Address:
Address (cont):		City:
State:		Zip Code:
Country:
Tax ID/SSN:	Only if in US