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CB Ambassador Application

Please take a moment to fill out the form.

Applicant Name (First & Last)

Birth Date

Where did yo hear about Country Bubkins?

Facebook

Instagram

Tik Tok

Word of Mouth

Markets

Other

Email

Best Contact Number

Address

Are you currently a brand ambassador for any other affiliates?

YES

NO

If YES please list name/s of company below

Facebook link:

Instagram link:

Tiktok/other link:

Please tell us about yourself/your little one and why you would be perfect to represent Country Bubkins?

Have you purchased from us before?

YES

NO

Please upload photo/s that best represent applicant

Upload File

Upload supported file (Max 15MB)

Thanks for your interest!

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Thanks for submitting!

0455990816

Boggabri, NSW 2382

A Small Town,

AUSTRALIAN RURAL BUSINESS

abn:29700396981

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