Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Partners Program Questionnaire
Healthy Paws Pet Insurance - Partner Program
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Contact Person Full Name
*
Your answer
Type of account
Affiliate
Influencer
Rescue/Shelter Group
Employee Benefits
Clear selection
Email Address
*
Your answer
Company Name
*
Your answer
Website
*
Your answer
Address 1
*
Your answer
Address 2
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Number of Employees
*
Your answer
Healthy Paws Policy Holder
Do you currently have Healthy Paws Pet Insurance for any of your pets?
*
Your answer
Choose the closest approx volume of your website
What is your website traffic volume per month? Unique visitor.
*
Choose
5,000 unique visitor or less
7,000 up to 10,000
10,000 to 25,000
25,000 to 50,000
50,000 to 100,000
100,000 or more
What type of business entity do you have?
*
Choose
Sole Proprietorship
General Partnership
Limited Liability Company (LLC)
Small Business Corporation (S-Corporation)
C-Corporation
Other
What year did you start your business?
*
Your answer
Additional Notes
If you have any additional information you would like to share for consideration, please share below.
Your answer
If you are a California resident, please read our
Notice at Collection
.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Healthy Paws Pet Insurance.
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report
