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Affiliate Details

Referred by: Dr. Tim Harrigan

Your First Name *

Last Name *

Desired Username *

Contact Information

Your Email - Do NOT Use An Email Previously Associated With A Customer Account *

Please confirm that the email listed above has never been used to make a purchase from the Synergy Wellness Formulas store. *

Correct, this email has never been used.

Phone *

Commission Payment Information

Mailing Address *

Address Line 1

Address Line 2

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Postal Code

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Additional Information

How do you plan to promote us?

Your Website / URL (If you plan to promote via an existing website)

(800) 997-8651

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FDA DISCLAIMER: The statements made regarding these products have not been evaluated by the Food and Drug Administration. The efficacy of these products has not been confirmed by FDA-approved research. These products are not intended to diagnose, treat, cure or prevent any disease. All information presented here is not meant as a substitute for or alternative to information from health care practitioners. Please consult your health care professional about potential interactions or other possible complications before using any product. The Federal Food, Drug, and Cosmetic Act require this notice.

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