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WALK

WATER

SPA

RELAX

SUN

New Customer Information Form

Product for Purchase

WALK Treadmill

WATER Treadmill

SPA

RELAX & SUN

RELAX

SUN Solarium

WALK Treadmill Additional Add-Ons:

SUN Solarium Additional Add-Ons:

SPA Additional Add-Ons:

Is the Purchaser/Buyer the Primary Contact?

Yes

No

$

Card Information

Buyer understands, acknowledges, and agrees that if he/she fails to pay the Seller the remaining amount due, when it is due, for the purchase of said machinery, parts, or accessories, the NON-REFUNDABLE DEPOSIT shall be forfeited.

Is the Shipping/Service Address the same as the Billing Address?

Yes

No

Shipping Address If Different

Your Signature

Home
Get Quote
Rehab Center Locator
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New Customer Information Form

$

Card Information

OFFICE

Office: (561) 204-2199

Fax: (561) 214-4607

3141 Fortune Way, Suite 5,

SALES & PRODUCTS

Jill R. Townsend

Cell: (561) 818-0049

Jill@horsegym.com

Wellington, Florida 33414

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