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Affiliate Request Form

We appreciate your interest in referring our products to your customers. If you are approved as an affiliate you will receive a 5% Commission on all sales that are generated from having our link on your website.

Please fill out the following form completely and we will review your information and get back to your shortly.

Thank you again.

Theresa Dale, CCN, NP.
Traditional Naturopath
Medical Consultant President & CEO, The Wellness Center for Research & Education, Inc.
 
Please fill out the following form and click Submit when completed.
   
Name
Occupation
Company Name
Website Address
E-Mail
Address
City
State
Zip
Sellers Permit
Direct Phone Number
 
  

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