LiveFreeOnline.com Associates Program Registration Form

LiveFreeOnline.com™ Associate Program Application

Thank you for your interest in the LiveFreeOnline.com™ Associates Program. Please complete and submit the following form
to apply for participation in the Program.

Please provide the following contact information:

Payee name:
(individual or organization)

Contact name:
(to mail payments to and
correspond with)

Title:

Organization or company name:

Address Line 1:

Address Line 2:

City:

State:

Zip:

Work phone:

Fax:

Your email address:

Web URL:

Brief description of your Web Site and how you would like to link to our site (where you
anticipate placing the link graphics, for example)?

How did you learn about our associates program?

If this application is accepted by Live Free, Inc.: (1) you will then be eligible to earn referral
fees in accordance with the "LiveFreeOnline.com™ Associates Program Operating Agreement",
(2) we will provide you with graphical artwork options (banners and buttons) to use in linking
to our site; and (3) software installed on our site will allow us to track your click through
sales.

By completing and submitting this application, you acknowledge that you have read the
Operating Agreement and agree to all of its terms and conditions. A current copy of the
Operating Agreement is available here.