Easy Living - Home, Health, Personal Care, Medical Alert, Free Prescription Card, Medication Management and More

How do I become an Easy Living Affiliate or Affiliate - Provider?

Just fill out our Online Affiliate Agreement...

You are then on your way to becoming an Easy Living Affiliate, who will benefit from the additional revenue generated through the program, increased marketing through our web sites and referral network, access to Easy Living's Senior Service Packages, as well as receiving greater acceptance by being more important to the surrounding senior community.

We will contact you to schedule orientation and the installation of our proprietary software.

Affiliate Agreement Form

*=required field

*Company Name:
*Type of Business:
*Name of Contact:
Title:
Address:
City:
State:
Postal Code:
*Telephone:
Fax:
*E-Mail:
Requested Password:
Web_Site_URL (if any ?):
Geographical Area Served:
Type(s) of Service/Products Offered:

Under this Agreement will: Identify the specific requirements of your client and use Easy Living as your provider of health and personal services when appropriate. Assisting client with order selection of Easy Living Packages. Processing order by utilizing the EZ Link software and the Internet. Maintaining control/relationship with client. Providing services, if applicable, as an Easy Living provider (i.e. Care Management, Home Health Care, Etc.).
Under this agreement, Easy Living, Inc. will be responsible for the following: Provide EZ Link software to Affiliate. Schedule and monitor all services to be provided to Affiliate's clients. Train and provide client support to designated Affiliate personnel. Appropriate schedules and reports are made available. Use carefully screened providers to provide the highest quality services and maintain a system for quality control. Include Affiliate on Easy Living web site. Handle all inter-action with providers including billing, payment and the confirming of orders.
We would like to be a Provider of the following services: (Check all that apply) Care Management Home Health Transportation Food Service House Cleaning Other - Please Describe:
Number of seniors or caregivers contacted per month:
How did you hear about the Easy Living Program?
This agreement may be terminated by either party with a sixty (60) day notification. Please Note: By submitting this Agreement, you indicate your acceptance of the terms in this Agreement.
Accepted By:
Title:
Date:	/ /