Apply FREE to Became an Affiliate of Maritime GALLUS® Lamp

We welcome any company, individual or web master to apply for our rewarding (10% Commision) affiliate program at Maritime GALLUS® Lamp. Complete and submit your application below. Please note that all applications are processed manually.


 Contact Details
Company Name (if any): 
Contact Name: 
Valid Email: 
Verify Email: 
Phone Number (optional): 
Fax Number (optional): 
 
 Mailing Address
Address (line 1): 
Address (line 2): 
City: 
State or Province: 
Country: 
Zip or Postal Code: 
 
 Web Site
Web Site URL: 
Another URL (if applicable): 
 
 Your New Password
Password: 
Verify Password: 
 
 Commission Payment
Preferred Payment Method:
 Cheque
 Direct Deposit
 Paypal

Commission Rate: 10% of sale total
Make checks payable to: 
Notes or Comments: 
 
I have read and agree to the terms and conditions of Maritime GALLUS® Lamp
 
 

Contact Information

GALLUS® Lamp
Dept. Of Da Vinci Forum GmbH
Rathausgasse 1
CH-9320 Arbon
SWITZERLAND
Tel: +4171 230 1002