Affiliate Registration

First Name:*

Last Name:*

Email Address:*

Password:*

Confirm Password:*

Preferred Coupon Code:*

Where do you live?:*

How long do you spend on social media a day?*

Why do you want to represent Rebel Nation as a Brand Ambassador and have you ever been or are you a brand rep for another company, if so what was/is your experience?**

What social media channels are you active on? (Select all that apply)

What are your social media handles for all of your accounts? How many followers do you currently have on each of these platforms?**

Do you have experience with any of the following

What's Your Date of Birth?*

Have you purchased from Rebel Nation before?* Yes No

As an Ambassador how would you promote Rebel Nation and build our customer base? How much time are you willing to commit to marketing via social media?*

What type of content do you create?* Photos Videos Both

What's the most amount of likes you have gotten on a Social Media Post*

What do you love about Confederate Flag Merchandise and what is your interest in the industry?*

We’d love to know more about you – please use this space to tell us anything else you would like us to know about you!*

Do you agree to share publicly at least 10x a week* Yes No