Affiliate Program Application

Affiliate Program Application

Thanks for your interest in Medicine Counter Pharmacy(RightMD) affiliate program. We're so excited to get to know you more and hopefully form a great partnership.
Full Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Where do you plan to promote?*

FacebookInstagramTiktokYoutubeWebsite/BlogOther
Please provide the link of your top performing social page/s?
How did you hear about us?
Which country do you reside in?*
Should be Empty: