Fixed Rate Repair / Handpiece Repair Solutions

Affiliate Name*

Contact Person First Name*

Contact Person Last Name*

Address1*

Address2

City*

State*

ZIP Code*

Job Function

Telephone Number*

Email Address*

Thank you for becoming a Fixed Rate Repair Affiliate.
To complete the registration, please read and accept the Fixed Rate Repair Affiliate program guidelines.

View Affiliate Program Guidelines

I accept the Affiliate program guidelines.

Important: : In order to be paid your Affiliate commission, a completed W-9 must be emailed to info@fixedraterepair.com

Fixed Rate Affiliate Registration