ARTISTIC!'S EXPRESS AFFILIATE SIGNUP FORM

ARTISTIC! CAPITAL CORPORATION
NEW Affiliate Signup Form

Congratulations ....

Welcome! You definately made the right decision to consider our Broker Programs.
To start right now, just complete the form below and return to us by email or fax,
download our Loan Request Form and start giving it out to clients you know need funding.

Webmasters: A link will be provided to you at your request if you have
a website. If provided below, your links will arrive within 24 hours.

Instructions: Type in information requested, cut and paste into email or fax to us at: 1-866-RTISTIC! (1-866-784-7842) 24 hours per day, 7 days per week.

Bold and Red Indicates a Required Field.

EXPRESS Affiliate Signup Form

Name:

Email:

Company:

Phone:

Website URL:
(OPTIONAL)

Business TAX ID:
(REQUIRED)

Address 1:

State/Province:

Address 2:

Zip/Postcode:

City/Town:

Country:

Referred By:

Phone # (H):

SS #: (REQUIRED)

Phone # (W):

Date of Birth:
(REQUIRED)

Mother's Maiden Name
(REQUIRED)

PAYEE CHECK ADDRESS

Your

Commissions will go here.

Address 1:

State/Province:

Address 2:

Zip/Postcode:

City/Town:

Country:

We will email all appropriate links, banners and etc. when your application has been approved.

Thank you for visiting us:
www.artistic-capitalcorp.com

FAX TO: 1-866-RTISTIC! (1-866-784-7842) ► Email to: express_affiliate@artistic-capitalcorp.com