$4.74

First Name
Last Name
Username	( 4-25 characters )
Password	( 4-25 characters )
Password Again
E-mail
E-mail Again
	Mailing Address
Address 1
Address 2
City
State/Province	Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Foundland New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon
Country	Canada United Kingdom United States
Zip/Postal Code
	Additional Fields
Phone Number	XXX-XXX-XXXX. Enter a valid phone number (Number will be verified)
Paypal Account	This is your PayPal account email address (PayPal Verified accounts only). If you do not currently have an account, leave blank.
Date of Birth	MM/DD/YYYY Please enter your actual date of birth.
Age verification	By checking this box, you understand you meet or exceed the 18 years or older age requirement to join TheDollarPit. Yes, I am 18 years of age or older.
Fraud Policy	By checking this box, you understand that TheDollarPit reserves the right to ban any member's account at any time. Accounts will be banned due to “ANY” form of fraud or if the member has a history of fraud with other sites, advertisers or affiliates. I have read and agreed to the Fraud Policy.
Verification before payment	By checking this box, I understand that The DollarPit has the right to ask for a form of ID before I can receive my first payment. If I do not provide my ID I will not receive my payment when requested. I understand that The DollarPit WILL NOT share this information with any other member or other site owner. I AGREE
Where did you find or hear of us?	Tell us how you found us! =]
Notepad
Offers View	Disable Advanced Offers View.
	Other
Referred By
Security Code	Audible Code
	Yes, please send me e-mails regarding newsletters and/or notifications.
	I have read and agreed to the Terms and Conditions of The Dollarpit.