Pharmacy Affiliate Program

PharmacyHealth.net is looking for affiliates to help market certain products from our company. We extend affiliate relationships to companies who are already in the health industry or any related industry as it relates to our business and products.

Please supply us with the information below within an email as we are updating our affiliate system and will update this page within the coming weeks for easier processing. Affiliates will be reviewed and approved if their company or content fits our affiliate program.

Please Provide the following information and send it in an email to: info @ pharmacyhealth.net (without spaces), subject: Partner Program 1210

1) Name:

2) Main contact phone number (including area code):

3) Secondary phone number you can be reached at (optional):

4) Email address:

5) Primary Method(s) of marketing:

6) To obtain a privately branded online pharmacy you must select and register a domain name. There are several online companies that provide this service including: www.names4ever.com. Please enter your registered domain name:

7) To obtain a privately branded online pharmacy you must have a Windows host for your website. Please enter the name of your hosting company and write that it is a Windows host:

8) Indicate whether you prefer the templates emailed to you or uploaded via FTP (File Transfer Protocol):

9) If you selected FTP, note the address of the server: user name and password

Partner Payment Information:

We pay weekly for all shipped orders via Bank Wire: To receive payment, please enter the following information

10) Name of your Bank:

11) Address of your bank branch:

12) Name of your Bank Account:

13) Bank Account Number:

14) Bank Routing Number:

15) Bank SWIFT ABA:

16) Tax ID Number or Social Security Number: