Influencer Signup Form

Become an Urb Affiliate!

Email Address *

First Name *

Last Name *

Age (Must be 21+) *

Preferred Discount Code Name *

Where should we send your free URB to?

Address Line *

City *

Postcode *

Region *

Country *

Phone Number *

Select Your Free Product (subject to state restrictions) *

Let us know your social media accounts so we can check them out! At least one account is required.

Website/Other

Twitch

Facebook

We have received your application and will review it shortly!