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APPLICATION

AFFILIATES

FAQ

AGREEMENT

APPLICATION

CONTACT US

 

Affiliate Program Application

Affiliate Agreement Terms

Contact Information

Please fill out the name and address of the person in charge of the sponsoring website. This is the person to whom we will address all correspondence about your participation in this Affiliate Program.

Note: You must enter a password to protect your account
and you must enter the admin contact email address so that     we can contact you if required.

Administrative Contact Information
*
All Items Must Be Filled Out
Company Name:
First Name:
Last Name:
Address1:
Address2:
City:
State:
Postal:
Country:
Phone:
Fax:
Email:
Confirm Email:

Payee Contact Information

Please fill out the name and address of the person to whom we should send commissions earned through this program.

Click here if info is same as Admin info
Company Name:
First Name:
Last Name:
Address1:
Address2:
City:
State:
Postal:
Country:
Phone:
Fax:
Email:
 
Password :

Password (confirm):

Your
Website URL(S):

 
   

You will be contacted shortly by email with your special assigned URL and easy instructions on how to get everything set up immediately.

Keyword 1:



If you experience any problems, please email affiliates@ahealthya.com

 

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