Partnership Program Application

Partnership Program Application
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
TikTok Handle
# of TikTok Followers
Instagram Handle
# of Instagram Followers
If you are selected to participate as a Pura Vida Chicas partner, you will receive a box with three (3) unique products. Please select your preferred products below. Duplicate items will not be allowed.
Preferred Item #1*

3 oz. Magnesium Body ButterMagnesium Oil SpraySoothing Foot SoakPillow MistEmotional Support OR Wellbeing Aromatherapy Roller SetHot Girl SprayGlycolic Acid Facial CleanserArgan OilBath Salts
Preferred Item #2*

3 oz. Magnesium Body ButterMagnesium Oil SpraySoothing Foot SoakPillow MistEmotional Support OR Wellbeing Aromatherapy Roller SetHot Girl SprayGlycolic Acid Facial CleanserArgan OilBath Salts
Preferred Item #3*

3 oz. Magnesium Body ButterMagnesium Oil SpraySoothing Foot SoakPillow MistEmotional Support OR Wellbeing Aromatherapy Roller SetHot Girl SprayGlycolic Acid Facial CleanserArgan OilBath Salts
Should be Empty: