Affiliate signup
Affiliate Sign Up Form
  10% on all sales
The Nutiva Affiliate program will pay out 10% on total sales amount after discounts less shipping. Payments will be made monthly on account balances over $35.00. Monthly balances will accumulate until the minimum payment amount is reached. If you have any questions please contact the Nutiva Team at help1(at)nutiva.com

  Affiliate signup form
Affiliate program name 
Username 
Password 
If you are an existing user, please use your login credentials and register here  
Confirm password 
  User particulars
(Existing members do not have to fill in the next section)
Email 
Pay Pal Email 
Website URL 
Contact name 
Payee name 
Company
Tax ID or SSN
Applicable to US and Canada residents only
  Address
Street 
City 
State
Country 
Zip code 
  Contact
Phone number 
Fax number
I have read the affiliate agreement,
and I accept the terms 
license agreement

  Asterisk denotes mandatory fields that must be filled in.