influencer campaign intake form

Phone

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Start Date

MM

DD

YYYY

End Date

MM

DD

YYYY

Which affiliate network would you like to enroll in

TK

Opti

Amazon Associates

Impact

Pepperjam

Share-A-Sale

Rakuten

Payment Method

Paypal

Cash

Check

Credit Card

Purchase Order

Wire Transfer

Is approval needed for the content created?

Needed

Not Needed

Terms and Conditions *

Yes, I have read and approved the Terms and Conditions* below