Affiliate Program Application Form
Become An Ambassador And Join Our Mission To Spread Plant Medicine & Wisdom
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website
*
Instagram Handle
Facebook
Youtube
Twitter
Tell Us About Yourself
*
How do you plan to sell our products?
*
What is your Paypal handle to receive commission payments?
*
Are you 18 years of age and up?
yes
no
Please fill and submit a W-9 form which you can find
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