DocuWhiz Affiliate Program Sign Up

Affiliate Sign Up Form
Name*

First NameLast Name
Cell Phone*
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Email*
example@example.com
YOUR BACKGROUND
Who is your audience? Focus industry? (i.e. Residential Assisted Living, Adult Day Care, etc.)
Focus
Company
Website(s)
DocuWhiz User?
DocuWhiz Subscriber?
Your Reach
PayPal Account Email Address*
example@example.com
AFFILIATE CODE
Please select a code you would like to use. Must be 1 word of up to 12 alphanumeric characters.*
Code
We use PayPal to make payments to our Affiliate Partners. Personal PayPal accounts are fine. I agree to the DocuWhiz Affiliate Program Terms & Condisions, which Iunderstand will apply as I click the Submit to join the Affiliate Program. If I am applying on behalf of the company I indicate above, I am authorized to agree to these terms on behalf of that company.
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Affiliate Sign Up Form