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First Name
Last Name
Email
Phone	Your primary contact number
Address
City
State
Country
Zip Code
How long have you been a publisher/affiliate?
Are you currently running mobile CPA campaigns? If so, how long?
Please describe your qualification for marketing CBD?
What is your monthly revenue on all of your CPA campaigns?
How did you find out about Patriot Supreme?
Upon approval how long does it take you to get offers up, running and generating traffic?
What other networks do you work for?
What campaigns are you most successful with?
Are you doing this full-time?
Captcha	3 + 7 = ?