Affiliate Application Form

Affiliate Application Form

Apply to become an affiliate with the Clarity Cooperative
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
How did you hear about us?*
Other*
Industry*
Tell us what industry your business or services involve.
How do your services and products help therapists and other healthcare professionals support and grow their business? (i.e. your product helps people market themselves like business cards and other print materials or digital services like Google Ads, etc)*
We're looking to partner with affiliates who provide highly sought-after services to our valued members.
How do you typically price for products or services? (i.e. flat fee per product, monthly membership, etc). If you have previous experience partnering as an affiliate, how do you like to approach member perks? (i.e. % discount, introductory month free, etc)*
We're looking to understand how affiliate-member perks typically works between you and your clients.
Please include a link to your website that showcases your products or services, previous success stories with other affiliate partners, and/or client testimonials that sing your praise*
Please feel free to include any additional information that demonstrates the value you and your company might bring to the Cooperative.
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