Contact Name:*

Business Name:

Business Registration Number:

Phone Number:

Fax Number:

Postal Address:

City:

State:

Postal code:

Country:

Email Address:*

Web site:

What is your Business category?

• I have a current website and am looking to add flowers to my product range
• I am in the process of constructing a website and am looking to add flowers to my product range
• I currently have a website that sells flowers and am looking to change suppliers
• I have a current or potential Member Group (eg. shopping discounts, member benefits) and am interested in providing them with a discount on their flower purchases
• Other:

How do you hear about us?

• I searched for 'flower and/or gift affiliate programs'
• I searched for 'affiliate programs' in general
• I found Teleflora by searching using other keywords.
• I have seen Teleflora on other Affiliate sites
• I have been recommended to contact Teleflora by other Affiliates
• I have used Teleflora before
• Other:

Your commission or discount structure will depend on the way in which you'd like to trade with Teleflora. How would you like to collect your Teleflora orders?

• I'd like to place a link to Teleflora on my site to collect orders (Affiliate Option 1)
• I'd like to use my site's own shopping cart to collect orders (Affiliate Option 2)
• I'm unsure how to collect orders and need assistance to work out my best option

Orders collected through a shopping cart will need to be sent to Teleflora. How would you like to send these orders ?

• Online via the Teleflora Ordering Website
• Petals / Teleflora API Interface (XML)
• Unsure

This can be based on your other product sales if you have a current website.

• 1 - 10 orders per month
• 10 - 20 orders per month
• 20 or more per month
• Unsure

What is your site's current traffic stats per month:

How helpful was this site:

• 1 - Poor
• 2
• 3
• 4
• 5 - Excellent

Extra Information/Comments

What is the sum of 1 + 1?*

Thank you for registering your interest. We will contact with you to discuss your opportunities.