Beline Digital Sign Up Form

1

Hi there! What's your full name?* This field is required.

2

What's your best contact email?* This field is required.

example@example.com

3

What is your current follower count?* This field is required.

4

How about your instagram URL?* This field is required.

5

What's your best contact phone number?* This field is required.

Country Code

Area Code

Phone Number

6

How many comments did you receive on your last selfie?* This field is required.

7

Where are you located?i.e.- Los Angeles, CA

8

List all other relevant social accounts* This field is required.i.e. - TikTok, Youtube, etc.

9

How did you hear about us?* This field is required.i.e.- Instagram, a creator event, through a friend...