Partners Program Questionnaire

Healthy Paws Pet Insurance - Partner Program

Contact Person Full Name*

Type of account

Please select the type of account you're applying for:

Affiliate

Influencer

Rescue/Shelter Group

Employee Benefits

Email Address*

Company Name*

Website*

Address 1*

Address 2

City*

State*

Zip*

Social Media Links*

Please provide all your social media links

Number of Employees*

Healthy Paws Policy Holder*

Do you currently have Healthy Paws Pet Insurance for any of your pets?

Select

Pet Name*

Please provide us with Pet Name that has an HPPI Policy.

Choose the closest approx volume of your website*

What is your website traffic volume per month? Unique visitor

Select

What type of business entity do you have?*

Select

What year did you start your business?*

Additional Notes

If you have any additional information you would like to share for consideration, please share below.