Takara Belmont Affiliate Application

Contact Information

Legal Name*

First Last

Business Name

Instagram Username*

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province ZIP Code

Were you referred to this form by a Sales Representative?*

Which region are you in?*

Are you currently associated with any other brands' referral or affiliate programs?

If yes, please list them below:

Do you have any previous experience with referral programs or affiliate marketing?

If yes, please describe:

Tell us about your experience and interest in the beauty industry:

What specific products or aspects of our brand are you most excited to promote?

Do you own any Takara Belmont Equipment?

If yes, please list all products:

How do you plan to promote our products or brand to your audience?

What channels will you use to drive traffic to our ecommerce site? (select all the apply)

Comments

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