LoseTheBackPain.com's Affiliate Program


The Lose The Back Pain Affiliate Program is a great way for you to make some extra money while helping others eliminate their back pain and enjoy life again.


To ensure your application is approved, please answer each question completely with as much detail as possible. Failure to completely fill out the questions below will delay and/or possibly cause your application to be denied.


Additionally, I like to have a conversation with every potential application. Please make sure your contact info is correct.


I look forward to speaking and working with you!


Nicole Farley
Affiliate Manager


Contact Information
First Name *
Last Name *
Email *
Phone 1 *
Phone 1 Type
Street Address 1 *
Street Address 2
City *
Postal Code *
SSN or Tax ID (USA only) *
State *
Please provide your Skype ID.
Please provide a link to your LinkedIn Profile.
Website (If none, enter N/A) *
How did you hear about our program? *
How do you Intend on promoting our program? What are your marketing plans? *
Do you have experience in the health niche? *
Why do you want to promote our products? *
Do you have a mailing list? If so specify size *
Do you have Affiliate experience? *
If so, what kind of success have you had?
Referral Partner Signup Information
Username *
Password *
Retype Password *
Notify On Lead
Notify On Sale









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