Affiliate Application

Please complete the following information to join our Affiliate Programme today!

Contact Details
	Title* Required*
	Firstname* Required*
	Surname* Required*
	PhoneNo* Required*
	Email* Required*
Invoice Address
	Company* Required*
	Address 1* Required*
	Address 2
	City*
	Postal code* Required*
	Country*
	VAT No.(If applicable)
Delivery Address Tick box if same as above, or complete the following:
	Address 1*
	Address 2
	City*
	Postal code*
	Country*
Site Information
	URL of Site, e.g. www.emotionalbliss.com* Required*
Please provide us with a preferred Username and Password.
	Username* Required*
	Password* Required* Password must be at least 5 charcaters.
	Confirm Password Required*
By providing this information, you will be able to gain full-time access to your account and monitor your progress with real-time reporting and links. Before submitting your application, please read the Affiliate Programme Agreement which describes the Terms and Conditions of your participation in the EmotionalBliss.com Affiliate Programme. Once you have completed this form and reviewed the Agreement, press the YES, I AGREE TO THE ABOVE button to submit your application. By pressing the button, you agree to the following: •You want to participate in the EmotionalBliss.com Affiliate Programme •You have read the Affiliate Programme Agreement and understand its contents •You agree to be bound by the Terms and Conditions of the Affiliate Programme Agreement Before submitting your application, please ensure that questions marked * are completed as they are mandatory fields. All information submitted on this application will remain strictly confidential.

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