Creator Information Form

By submitting this form, you confirm that all information provided is accurate and complete, and you consent to the collection and use of your data for account creation and participation in the Bolt Ambassador Collaboration. Submission does not guarantee acceptance, and all applicants are subject to onboarding-team review and approval.

Full name *Gender *Email *The onboarding team will use this address for application and onboarding communication.PayPal email (optional)The email linked to your PayPal account, for payments. This can be different from your sign-in email. You can leave it blank and add it to your profile later.Referrer's name (optional)Referrer's PayPal email (required if referred)The email linked to your referrer's PayPal account, for referral rewards. Required when a referrer's name is provided.Phone number *Date of birth *Format: YYYY-MM-DDYour location *

Your top 3 country audiences *Enter all three countries, starting with your largest audience.

Country 1 *Country 2 *Country 3 *

Type of Collaboration *

Free Medication CollaborationFree Bolt treatment plan, subject to a clinical consultation, in return for an agreed number of Reels each month.Views Galore CollaborationGet paid monthly for your total organic views across all platforms.

Social accountsPaste the full profile or page link. Leave a field blank when it is not applicable.

Instagram accountTikTok accountFacebook pageYouTube page

I confirm that the information is accurate and consent to its use for account creation, application review, and participation in the Bolt Ambassador Collaboration.