MallKing.com Affiliate Sharing Program

This order form is 100% Secure!
Please fill out this form completely and press the "Submit" button.
If you have any questions, please call us at
805-528-2100
or send email to majon@majon.com

Affiliate Sharing Program Sign-up

Full Name:

Your MallKing ID (example: malljk2232 )

Referrer ID ** Optional -- Leave Blank if Unsure

Phone

Fax

E-mail Address:

Postal Address:
Address2:
City:
State:
Zip Code::

Country:

PAYMENT INFORMATION

Service Ordered:

Method of Payment:

Credit Cardr

Credit Card Number:     
     Expiry Date:

Check

If paying by check complete this section If you selected the payment by check option above, please provide us with your checking account information. You will not need to physically mail the check to us after completing this section. You may keep the actual check for your records. For help in identifying your checking account information please see our online check photo & diagram.

Name on Account: (As it appears on check) 

ABA Routing Number: (NOTE: Always a nine digit number) 

Checking Account Number:         

Bank Name:              
Bank City & State:   
Check Number:          
Amount of Your Check: