Affiliate Program Application Form

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	Country

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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