Affiliate U.S. Residency Verification Document of Pulsar Marketing Inc.


 This Document is to verify your U.S. residency for you to become an affiliate of Pulsar Marketing Inc.

  

Instructions:

1. Print this U.S. Residency Verification Document

2. Present this Document to a Notary Public.

3. While in the witness of a Notary Public, fill out the "Applicant" section, sign and date this form.

4. Have the Notary Public verify your information and complete the Notary Public Verification Section.

5. Mail this U.S. Residency Verification Document to Pulsar Marketing Inc:

  Pulsar Marketing Inc.

  16033 N. Big Hill Road

  Gulfport, MS 39503

 

Applicant Information (To be completed by You, the registering Affiliate)

  

a) Full Name: ________________________________________________________

  

b) Street Address or PO Box: ___________________________________________

  

c) City:_____________________  d) State:___________  e) Zip Code_________

  

f) Year of Birth: ______________ (for age verification)

  

g) Signature:________________________________________  Date:___________

   

Notary Public Verification Section (To be completed by a Notary Public)

 The Applicant's (Affiliate's) Information in Items a) through g) of this U.S. Residency Verification Document was verified by comparing the information the Applicant (Affiliate) presented on this Document with his/her valid, state or government issued photo ID.

Notary Name (print)_________________________________  Date:___________

Notary Signature ___________________________________

Notary Phone Number (________)______________________


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Affix, Stamp, or Imprint Notary Seal >

Disclosure/Privacy Policy: Pulsar Marketing shall use your information to verify your identity, age, and to provide you access to our affiliate programs.  Pulsar Marketing does not charge you any fees.
Pulsar Marketing shall not disclose your information to any other party without your expressed consent.
Pulsar Marketing has appropriate security measures in place to protect your information.
For support assistance, visit www.PulsarMarketing.com.  Forms not accepted via Fax nor Email.