Practitioner Affiliate Registration

Register as a Practitioner Affiliate

By filling in the form below you will be registering as a Recovery Factors Practitioner affiliate and earn 15% commission on every sale your referrals make. A referral link and a discount coupon for your clients, will be provided to you once registered.

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Name*

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Username*

Password*

Enter Password Confirm Password

Email Address*

Website

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Payout Options*

Where would you like your payouts to be paid to

Account Holder Name*

Account Number*

Bank Swift Code*

Bank Address*

Payoneer email address*

Click here to view the terms and conditions

Agree to Terms and Conditions*

By Clicking this checkbox, you agree to the Terms and Conditions

Comments

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Practitioner Affiliate Registration

Register as a Practitioner Affiliate

How It Helps

Background

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