AQUA MASSAGE SUPPLIES & PROMOTIONAL MATERIALS
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Aquaseal – for barrier repairs
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Aromatherapy Pad – felt pad with guard & magnet
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Barrier Patch 12” x 12”
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Business Cards, Photo
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Business Cards, Photo
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Cleaner, Industrial Plastic – Polish for acrylic windows
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Cleaner, Stainless Steel – Stainless steel cleaner / polish
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Cotol (0.5 oz.) – Cleaner/accelerator for Aquaseal
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Electrical Schematic
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Face Paper, XL/HP/PT -1-24 rolls
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Face Paper, XL/HP/PT - case (25 rolls)
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Face Paper, Spa Model (100 sheets/pack), 1-9 packs
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Manual, Operations – includes Schematic
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Manual, Operations – includes Schematic
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Manual, Technical Service – includes Operations Manual/Schematic
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Manual, Technical Service – includes Operations Manual/Schematic
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Standard Poster Set – two 11”x 17” posters-one each Benefits Poster & Sales Promotion Poster
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Water Treatment, Instant Ions Kit – includes water test kit & solution
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Water Treatment, Instant Ions1 oz. bottle
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NEW CUSTOMER / EXISTING CUSTOMER UPDATE INFORMATION:
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Person Completing Form:
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Prefix
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First
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Last
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Suffix
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Date:
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MM
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/
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DD
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YYYY
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Owner Name:
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Serial Number:
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Business Name:
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Serial Number:
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Type of Business:
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Serial Number:
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Home Telephone Number:
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Business Telephone Number:
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Mobile Telephone Number:
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Email Address:
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Billing Address:
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Street Address
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Address Line 2
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City
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State / Province / Region
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Postal / Zip Code
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Country
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Delivery Address:
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Street Address
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Address Line 2
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City
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State / Province / Region
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Postal / Zip Code
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Country
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Physical Address:
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Street Address
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Address Line 2
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City
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State / Province / Region
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Postal / Zip Code
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Country
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MACHINE INFORMATION:
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Unit From (prior customer #, Name):
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Date Unit Obtained:
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Hours on Unit:
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SHIPPING INFORMATION:
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Select Shipping Method:
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Federal Express
U.S. Only
UPS Ground (U.S.
Only)
Priority Mail
(U.S. Only)
Priority Overnight
2-Day
First Overnight
Saturday Delivery (Additional Charge Will Apply)
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Is this a residence?
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YES
NO
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INTERNATIONAL ORDERS & SHIPPING:
For all international orders/shipping, please contact AMI directly via e-mail (sales@aquamassage.com) or telephone (860-536-3735).
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PAYMENT INFORMATION:
Credit Card information will be requested when you are contacted by AMI with a complete quotation including shipping.
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For orders less than $40.00, add an additional $15.00 handling charge.
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