Media Application

First Name *

Last Name *

Birth Date *

Email *

Accept to receive notifications by email.

Address

First name (optional)

Last name *

Company

Full address *

Apartment, suite, etc. (optional)

City *

Country/Region *

Province/State/Region *

Postal code *

Media Outlet Name *

Type of Media *

Select all that apply

Instagram

Facebook

YouTube

TikTok

X

Other

Link to Media *

Link to Media 3

Link to Media 4

Link to Media 2

Purpose of Product Use *

Select all that apply

To be featured in content

Review

Giveaway

Installation Video

Informative Video

Other

Have you used our products before? *

Yes

No

Products Requesting *

Standard MTB Grips

Engraved Grips

FIT Grips

XL/XXL Grips

Silicone Tape

Detailed plans for product use: *

Do you have experience with other Media Partners? Please give examples *

Would you like an affiliate link & code to earn commission and give a discount to your followers (must be 18 or older)? *

No Thanks

20% Commission/10% Discount

15% Commission/15% Discount

10% Commission/20% Discount

0% Commission/30% Discount

If you requested an affiliate code, what would you like it to be:

I acknowledge that using the ESI Grips brand or affiliate code to solicit or sell other people's personal information is prohibited.

Order products

Order Total (The sum of all the prices of all the items in the order, taxes and discounts included.)

Contact information

Shipping address

Billing address