Affiliate Program

If you already have an account with us, please login at the login page.

To create an affiliate account, fill in the form below ensuring you complete all the required fields:

Your Personal Details

* First Name:
* Last Name:
* E-Mail:
* Telephone:
Fax:

Your Address Details

Company:
Web Site:
* Address 1:
Address 2:
* City:
* Post Code:
* Country:
* Region / State:

Payment Information

Tax ID:
Payment Method:
Cheque Payee Name:
PayPal Email Account:
Bank Name:
ABA/BSB number (Branch Number):
SWIFT Code:
Account Name:
Account Number:

Your Password

* Password:
* Password Confirm:
I have read and agree to the Terms & Conditions
Note:  A prescription from your physician or an approved medical license must be provided to purchase a WellnessPro​​ or any accessories. 
Powered By OpenCart
Electromedical Technologies © 2020