Affiliate Program Application

Affiliate Program Application
Contact Details
Contact*

First NameLast Name
Company Name (If you are not a company write n/a)*
What email address would you like to be contacted through?*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Your Website:
Have you used any of these programs yourself?*

YesNo
What programs would you like to share?*

Healthy for Life MembershipFit FusionBreathe & StrengthenOther
How do plan to share these programs?*
Will you follow all email marketing and anti-spam laws, which include disclosing you are an affiliate?*

YesNo
Commission Payment
Commission payments are made monthly to your Paypal account. You don't need to have a business account, a standard Paypal account is acceptable.

Affilate commissions are 35% and just a way to say thank you for your referral!
Paypal Account E-mail*
After I receive this form, if you are accepted I will send you an affiliate contract via email to fill out.

Please be on the lookout for an email from me.

If you don't receive an email from me within 48 business hours please reach out to me at michele@healthybeyond40.com
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