AFFILIATE VENDOR INQUIRIES
Your Name:
Title:
Company Name:
Company Address:
City:   State:   Zip:
Country:
Telephone #: Fax #:
Website:
Email:

Please choose a description that best suits your company:
Mass Merchant
Specialty Retailer
Manufacturer/Supplier
Catalog/Mail-Order Merchant
Other

Please list your primary three product catagories:
example - 1. juvenile furniture 2. maternity apparel 3. toys
1. 2. 3.

Do you currently have an Affiliate Program in place? YES NO
— If YES, do you administer this yourself? YES NO
— If NO, please provide the name and web address (URL) of the company that administers this program for you.

Who should we contact to obtain more details or to discuss your Affiliate Vendor status at FirstBabymall.com? (provide contact name only if different from form submitter)

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