The Data Widget
To create an Affiliate Account, complete the following information and click the Submit Registration. You will receive an activation email at the email address you provide with further activation instructions. If you have questions about this registration process, please Contact Us.
General Information
Company Name*
Contact Name*
Street Address 1*
Street Address 2 
City Name*
Zip Code*
Phone Number*
Your Contact Email Address*
Confirm Contact Email Address*
Tech Support Email*
Data Widget Interface Configuration
This Data Widget Checkout site uses the Data Widget interface provided by Leads Please. The following fields are used by this Data Widget interface. In order to use the Data Widget interface, you will first need to have a Data Widget account with Leads Please. If you do not yet have an account with Leads Please, you can request one by contacting Leads Please directly at 866-306-8674 or by emailing them at

You can choose to leave these values blank at this time but will need to define them before using your account Data Widget Checkout account.
Affiliate Code
Affiliate Username
Affiliate Password
Widget 'Buy' Button Label
Affiliate Email2
Submit Profile