Welcome to VALIS International !

Personal Accounts are not currently available. (Coming Feb 1, 2002)
However, any affiliate can still sign up and receive the commissions via PayPal

Affiliate Package, Personal US Checking Account, and/or
US Address Application Form

Choose your Program
	Free Affiliate Program

How you found us:

A. Who You Are
Full Name:
e-mail address (use the address given to you by the ISP you are using to connect) (no webmail or free addresses- hotmail, etc.):
Your Site:
First Name:
Middle Initial (Optional):
Last Name:
Home Phone Number:
FAX:
Date Of Birth:
Passport #:
Home address
Street:
Additional Street
City:
Province / State:
Postal Code:
Country:

B. Affiliate and Login Info
Preferred User Name (Affiliate/Login ID):
Password and Password Confirmation (6-10 characters):

C. Mail Forwarding Address (Complete only if ordering Gold)
Street:
Street (additional):
City:
Province / State:
Postal Code:
Country:

D. Payment Information
Preferred Payment Method:

E. Purpose of InterCash Account and/or Address
What will you be using the US Checking account and/or US address for?	To receive VALIS affiliate payments and

Requirements:
scan of Passport
scan of paper Utility Bill showing your name and address
Mailed/couriered to us:
signed and dated Signature Card
possibly a Bank Reference (your local bank)