New Customer Registration Form

1
Full Name* This field is required.
First Name
Last Name
2
E-mail* This field is required.
example@example.com
3
Phone Number
4
How did you hear about us?* This field is required.
Google
Social Media
Word of Mouth
Our Website
Other (Please specify...)
5
On average, how many followers/subscribers do you have on social media?Any platform.
0-500
500-1000
1000-5000
5K-10k
10k+
6
How active are your followers/subscribers?Let us know about your authentic audience engagement. When responding to this question think about the genuine connection you have with your audience(likes,comments,story views,etc.)
Not Active
Highly Active
7
Are you a part of any engagement groups?
YESNO
8
Are you a part of any other affiliate marking programs?
YESNO
9
If so, what is your success rate?What is your average click/sell rate per month?
10
Please list your social media handles along with the associated platform.
11
What is your ultimate goal in joining our affiliate program?Short answer.
Should be Empty: