Affiliate Registration

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E-mail*

First name*

Last Name*

Password*

Must be 6 or more characters and contain at least 1 letter, 1 number and 1 special character (! $ # - .)

Repeat Password*

Desired Coupon code*

You must fill at least one field for website or social site

Website / BlogFacebookInstagramYouTube

Company Name

Age*

Phone*

Address

City*

State*

Postal code*

Comments

Paypal Address*

Fields marked with * are mandatory

I accept the Terms of Use and Privacy policy of this Affiliate program (read them here)

I accept the Terms of Service and Privacy policy of Affiliatly.com

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Thank you for your interest in becoming a Bezzie Ambassador. Please complete the application form. Upon review, a Bezzie staff member will contact you to provide more information. If you have any questions, please email us at support@bezzielashes.com.

Bezzie Lashes Ambassador Program

Affiliate Registration