Affiliate Reseller Enrollment

Affiliate Reseller Enrollment

• 1. Contact Name * First Last
• 2. Business Name *
• 3. Email *
  Confirm Email *
• 4. Phone * - ### - ### ####
• 5. PayPal email (to receive commission payments) *
• 6. Enter your desired PROMO code (must include at least ONE letter) *
  Must be between 4 and 10 characters.   Currently Entered: 0 characters.
• 6. Website
• 7. Are you currently promoting other B2B products or services? *
  No Yes, I am promoting the following
• If "yes," in what cities, states, or countries are you promoting?
• 8. Do you currently work with, or have relationships with independent, franchised, or specialty retailers? *
  No Yes
• If "yes," please elaborate and include cities, states, or countries