Referral Partner Application
First Name*
Last Name*
Company
Street Address 1*
Street Address 2
City*
State / Province*
Postal Code*
Country*
Email*
Phone*
Facebook
Commissions Payable To:*
I understand that I must have a PayPal Business account in order to receive your commission payout.
PayPalEmailAddress*
Who referred you to our partner program?*
What is your profession?*
What is your website URL?*
How many active contacts are on your email list? *
How do you plan to promote BrainTime?*
One-on-one with your clients
Promotional emails?
Zoom or Facebook Interview
Other
If you clicked "Other", let us know here:
Would you like to be notified when your referral makes a purchase?*
BrainTime Referral Partner Agreement
I have read and agree to all terms of the BrainTime Referral Partner Agreement*
Submit