Apply to be a Referral Agent Now

First Name *

Last Name *

Email *

Phone *

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. You can reply UNSUBSCRIBE to unsubscribe at any time.

Address *

Street Address

City

State

Country

Postal code

What Industry Do You Currently Work In? *

Do you have an existing network or audience you plan to refer from? (Business network, Friends/Family, Online audience, Social media following, Other) *

Approximately how many people are in your network that may be a good fit for our offers? (Under 100, 100–500, 500–1,000, 1,000+) *

Have you ever referred business before or participated in an affiliate/referral program? (Yes/No) *

If yes, please describe briefly...

Why are you interested in becoming a referral partner with Referral Royalties? *

How much time per week do you expect to dedicate to referring? (Less than 1 hr, 1–3 hrs, 3–5 hrs, 5+ hrs) *

How would you prefer to receive referral payouts? (ACH/Direct Deposit, PayPal, Check) *

Do you already have a business entity or will you be referring as an individual? (Business/Individual) *

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By checking this box, I confirm that I have reviewed, completed, and agree to submit the required information as outlined in the IRS Form W-9.

I agree to provide a W-9 before receiving commission payments. *

I agree

By checking this box, I confirm that I have read and agree to the Referral Agreement and its terms and conditions.

I agree with the Referral Agreement. *

I agree

I understand that Referral Royalties requires signed agreements and compliance with ethical referral practices. *

I agree