Partner With The Industry Leader 

Email*

Phone number*

Street address*

Type of industry*

Name of business*

How long have you been in business (years)?

Website URL / Instagram / Facebook

Tell us why you want to become an Affiliate?* (100 word max)

How do you plan to promote Health Mate?* (200 word max)

Affiliate Partners are required to file an W9 (independent contractors). Do you agree?*
YesNo