Affiliate Registration – Premier Business Alliance

This form must be filled out to recieve your affiliate payout

Affiliates are paid once a month at the time of their next monthly membership billing date. Please submit this form no later than 1 week after your next billing cycle. If you are late in doing so you may not be paid till the following billing date.

Affiliate Claim Form

First Name

Last Name

Member Email

Company Name

Where would you like us to send your check?

Address Line 1

Address Line 2

City

State

Zip Code

Country

Payment Disclosure

Affiliate payouts are determined on membership level. Only paid members will receive affiliate compensation. Those members with a Premier Growth membership will receive 15% of the total net pay of referral signups. If a referral signs up as a free member, the affiliate will receive $0.00 as part of their 15%. 15% of a paid member at $49.00 a month will receive $7.35 each month from that one referral membership as long as the member continues to stay active with their membership. The affiliate payout percentage changes dependent on which membership you choose. PBA currently offers two memberships. A free membership, which does not participate in the affiliate program, and a paid membership of $49.00 per month, which offers a 15% affiliate payout. Affiliates are paid once a month at the time of their billing cycle for their membership monthly renewal. You may choose to use your affiliate money towards your paid membership. Please contact us using the form on the "About Us" page to request this option. You are responsible to pay for any taxes that result from your affiliate payout. We will need a filled out and signed W-9 (A request for taxpayer Identification number and certification form). You can find this form at https://www.irs.gov/forms-pubs/about-form-w-9. Note that any payout over $600.00 a year requires a 1099, which we will provide for you at the appropriate time.