BECOME AN AFFILIATE

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Contact Information

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Company Name

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By checking this box I confirm I have read, understand, acknowledge and accept ScopeShield, Inc.'s Affiliate Agreement, and I agree to be bound by its terms.

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Certification of Authority *

By checking this box I acknowledge, represent and warrant that I have the authority to act on behalf of the Company (if a company) entering into the ScopeShield, Inc.'s Affiliate Agreement and described in this Application, and I acknowledge, represent and warrant that all information is true, complete, and accurate, and I will keep all such information current with ScopeShield, Inc..

1574 Coburg Road #386
Eugene, Oregon 97401
Telephone: 541-225-5902

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