Partner Program Application • eyepower

PARTNER PROGRAM APPLICATION

We would welcome applications from any individual or business currently operating in an appropriate field.

An appropriate field is considered to in the general health and well-being sector.

eyepower red is not a medical device and should be solely marketed as a personal well-being product intended to contribute to long term healthy vision.

Affiliate Registration

Name(Required)

First Last

Business Name

Are VAT Registered? (UK and EU only)

Yes

VAT Number (UK and EU only)

Email(Required)

Website / URL(Required)

Country(Required)

Current Business Activities & Market Sector(Required)

Planned eyepower Marketing Strategy(Required)

Login Details

Username(Required)

Password(Required)

Enter Password Confirm Password

Phone

This field is for validation purposes and should be left unchanged.