Via1 Enroll

Become a Via1 Affiliate Partner

Sign up now for the Via1 Verio Affiliate Program and earn additional monthly revenue by selling Verio Web hosting services. If you should have any questions, please call our Sales Department at 1-888-224-9346 to speak with a Sales Associate.

One Simple On-line Signup Process:

Complete the Affiliate Partner Profile form below, which will provide Verio with basic information about your business
Read and acknowledge the online Affiliate Program contract (also available in word and pdf formats)
Complete the appropriate online IRS tax reporting form for commission payouts

Once you’ve completed the form below, we will review your application. After approval Via1 Affiliate Partners are provided with marketing tools and banners that make it easy for you to co-brand your website. You can then start selling hosting accounts!

Sign Up For Affiliate ProgramSign Up For Affiliate Program

Required Enrollment Forms

* Indicates a required field

Affiliate Information

* First Name:		* Last Name:
* Email:		* Password:
Company:		* Phone:
* Address:		* City:
Address2:		* Zip Code:
* State:	Other:
* Country:

Payment Information

SS#/Corp ID#/ABN:
Make Payment To:

Site Information

* Website 1
Add additional websites (up to 5) [Add]
* Site Type
Referred By (if applicable)
Select the categories your site falls under:
* Category 1
Category 2
Category 3
Comments
* Company Size	Large Small

Socioeconomic Information

Please indicate if any of the following special business designations from the Federal Government apply to your company.

* ANC/Indian Tribes	Yes No
* Veteran-owned Small Business	Yes No
* Service Disabled Small Business	Yes No
* Woman-owned Small Business	Yes No
* HubZone Small Business (SBA certified)	Yes No
* SDB-Small Disadvantaged Business (SBA certified)	Yes No
* DSB-Disadvantaged Small Business (State certified)	Yes No
* WBE-Women Business Enterprise (State certified)	Yes No
* MBE-Minority Business Enterprise (State certified)	Yes No

* Debarment/Suspension Status
Is the company suspended, debarred or ineligible for entering in contracts with Agencies of the Federal Government, or in receipt of proposed debarment or suspension from any Federal Agency? Yes No

Debarment/Suspension/Expiration Date
The company agrees to and shall provide immediate notice to a Verio Representative if suspended, debarred or declared ineligible by any Department or Federal Agency, or upon receipt of a notice of proposal debarment or suspension for a DoD Agency.

NOTICE: In accordance with 15 U.S.C. 645(d), any person who misrepresents a firm’s proper size classification shall (1) be punished by imposition of a fine, imprisonment, or both; (2) be subject to administrative remedies; and (3) be ineligible for participation in programs conducted under the authority of the Small Business Act.

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