ShopHer Media Partner Portal

Become an Affiliate

Contact Information

*First Name:
*Last Name:
*E-mail Address:
*Confirmation E-mail Address:
*Password:	Password must contain at least 6 characters.
*Phone Number:	Used to verify your application.

Company Information

Payment Information

*Tax ID/VAT or SSN:

Type:

TIN (xx-xxxxxxx)

SSN (xxx-xx-xxxx)

Other

Make Payment To:

*Payment Type:

Tipalti

Account Name:
Account Number:
Routing Number:
Bank Name:
Bank Address: (City, State, Country and Zip)

Terms and Conditions

By submitting this application, you agree to the following terms and conditions:

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