LaJeanell Influencer Program Form

Thank you for your interest in joining the Influencer Program! Please fill out this form and make sure all your information is correct. We will be in touch if we think you are a good fit.

Don’t worry if we don’t reach out right away! We will keep your application on file, as we are adding new diversified individuals, on a consistent basis for the Influencer Program. Learn more about the promotion here.

Name *

First

Last

Email *

Date of Birth *

Gender *

• Female
• Male
• Nonbinary
• Other

Shipping Address *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Skin Type *

• Dry
• Oily
• Combination
• Sensitive
• Acne
• Other

Skin Concerns *

• Aging: fine lines, wrinkles, sagging, etc.
• Dullness: tired, sluggish and/or lifeless skin
• Flaking, dryness and/or dehydration
• Hyperpigmentation: discoloration, scars and/or spots
• Sensitivity: redness, irritation, etc.

Please note any skin conditions and allergies to ingredients/medicines here. If not applicable, please write N/A. *

Please provide a link to your public Instagram, website, portfolio, etc. to showcase your ability to deliver clear, quality photo and video content. *

Why should we choose you and why do you want to participate in the LIVE THE LAJEANELL LOOK promotion? *

If there is any additional information you'd like to provide about your skin concerns, current routine, types of product you like/prefer or do not like, or anything else related to skin care, please let us know here. If not, please write N/A.

Can you commit to sending us varied, high quality content regularly over the course of 3-4 months for every shipment we send you? *

• Yes

I acknowledge by submitting this form that I am not guaranteed to be chosen for the LIVE THE LAJEANELL LOOK, promotion. I understand I am a willing applicant in hopes of becoming a reliable participant. *

• Yes

Verification *

Type GLOW in the box below:

(This helps us reduce junk mail)

Submit

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