To become an affiliate, please complete the form below. Please download the W9 FORM, complete it, and submit with this form as part of your application. If you do not have the capability at the time, you can fax your forms to 913-214-1945.

Once you are approved, a Life Support Health Products team member will be in touch to finalize the application and help you get set up in our store. We compensate affiliates on a monthly basis.