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.


How do you plan to promote the Alphagenix brand?

Please choose a referral id

Set the ID you wish to have in your affiliate links to us, e.g.

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

Contact Details

Your point of contact and organisation info.

Please enter your first name.

Please enter your last name.

Please enter your email.


How would you like paid?

Payment Method

Please add your Paypal email / username.

Please add your Account Number.

Please add your Sort Code.

Please add your Bank Name.

Please add your Bank Address.

I have read and agree with the terms & conditions.

You must agree to our terms and conditions to proceed.