Secure workflow placeholder

Partner Activation

This page is a front-end template. Connect the form to your privacy-reviewed secure endpoint before publishing. Do not activate a payout profile from a public static form until acceptance and verification are complete.

Legal business name Display name

Authorized contact Role / title

Business email Phone

Provisional Partner ID Preferred contact channel

Business address I confirm I am authorized to submit this activation request. I have reviewed the current Referral Display Partner agreement and understand that the agreement controls compensation and eligibility. I will use only approved product, wellness and earnings language and will not make medical or income guarantees. I understand that a QR scan does not create marketing consent. I would like to receive optional ReferLife partner updates. (Leave unchecked unless desired.) Electronic signature Date

Production note: Add the agreement URL, privacy notice, secure form endpoint, payout verification step, orientation booking link and support contact before going live.