Join our Partners Program

Please fill out the form below to join our Partners Program. Required fields are marked with a red asterisk.

Your Organisation

Tell us a bit about yourself.

Website

https://

About

How do you plan to promote the Alphagenix brand?

Referral ID *

Please choose a referral id

Set the ID you wish to have in your affiliate links to us, e.g. https://alphagenix.co.uk/#myReferralID

Parent Affiliate

The name of the affiliate who has introduced you to this affiliate program.

Your point of contact and organisation info.

First name *

Please enter your first name.

Last name *

Please enter your last name.

Email address *

Please enter your email.

Country

Street address

City

State / Province

ZIP / Postal code

How would you like paid?

Payment Method

Paypal Email *

Please add your Paypal email / username.

Account Number *

Please add your Account Number.

Sort Code *

Please add your Sort Code.

Bank Name *

Please add your Bank Name.

Bank Address *

Please add your Bank Address.

Terms & Conditions

I have read and agree with the terms & conditions.

You must agree to our terms and conditions to proceed.