Wellness Technology Sales Form

Please complete and submit the form below to start your order!

Product *

Quantity *

Buyer Information

First Name *

Last Name *

Phone *

Email *

Occupation *

Company Name (If Applicable)

Billing Information

Billing Full Name *

Billing Address *

Delivery Information

We recommend that you have the Wellness Technology product(s) delivered to its intended long-term home, as our delivery team will be placing the unit into the desired room/space. No Assembly is required! We recommend professional movers should you need to relocate the Wellness Technology product(s) in the future.

Delivery Address *

Delivery Times:

Within the USA: Approx. 2-3 weeks from sale once the invoice is paid in full and the QEWB Customer Agreement is Signed.
International: Approx. 45 Days from sale once the invoice is paid in full and the QEWB Customer Agreement is Signed.

Customer agreement and invoice will be emailed to the buyer via PandaDoc and QuickBooks respectively. Be sure to check your spam/junk.

Is Your Delivery Address a Residential or Commercial Space? *

Residential Space

Commercial Space

Other

If Other, Please Specify:*

Large Wellness Technology products such as the QEWB can weigh 185 lbs., our white glove delivery team will move the bed into position for the buyer.

How Many Stairs Are Required To Bring The Product Into The Designated Room Upon Delivery?*

Point of Contact Information (If different from Buyer Information above)

Point of Contact Name

Point of Contact Phone

Point of Contact Email

Welcome Kit Details

Please select a T-shirt size for your Wellness Technology Welcome Kit!

T-Shirt Unisex Size Chart

Welcome Kit Shirt Size*

X-Small

Small

Medium

Large

X-Large

XXL

XXXL

Marketer Information

Marketer Full Name*

Marketer Phone*

Marketer Email*

Additional Marketer Information (If applicable)

Marketer Team Name

Marketer Parent Name

Wellness Session WT Owner Name

Additional Notes

Wellness Technology Sales Order Form