Affiliate Form

1
Would you like to remain anonymous in the event your submission is selected?* This field is required.If you select yes, please feel free to change any identifying information in your submission. We will contact you via Instagram DM if you have been selected.
YESNO
2
Name* This field is required.
First Name
Last Name
3
Email* This field is required.
example@example.com
4
Phone number* This field is required.
Please enter a valid phone number.
5
What is your Instagram Handle?* This field is required.
6
How long have you worked in the hair industry?* This field is required.
7
What are you struggling with in your business? * This field is required.
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Ok
Ok
8
Why do you feel like you are struggling with this in your business?* This field is required.
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Ok
Ok
9
What solutions have you thought of?* This field is required.
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Ok
10
Have you implemented any solutions? If not, what do you feel is holding you back from doing so?* This field is required.
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Ok
11
Is there anything else you would like to add?
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Ok
12
If you selected to remain anonymous, your identifying information will not be shared. If you did not select to remain anonymous identifying information will be shared.* This field is required.
YES, I understandNO, I do not understand
Should be Empty: