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Personal Details

Your First Name*

Your Last Name*

Business Trading Name

Your Phone Number*

Your Email Address*

Address*

Tell us about your business, passion or sport that led you to Nuzest*

Do you currently take Nuzest products? Yes No

Social Media

Website

Facebook

Instagram

Youtube

Would you be willing to promote Nuzest to your social media network on a regular basis? Yes No Maybe

How did you hear about the affiliate program? Friend Staff member Email Social Media Sports association/Gym/Pt or Other Blog or Publication REPs Other

Affiliate Code

Choose your discount code (Up to 8 letters and/or numbers)

Payment Details

Bank Account Name

Bank Account Number

Read the terms and conditions here.

Whilst we would love to have everybody onboard, The Nuzest Affiliate Program can only accept a limited number of partners.

I agree to the terms and conditions