Corp Registration

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Refreezable Cold Therapy Wrap

Corporate Customer Account Registration Form

The following form will allow Fixyourbody.com to perform a verification check on your company. Once verified your company will be issued a "Customer Code" which allows you and your employees to order online. Payment will be processed via invoice through E-mail or direct mail. If you have any questions please Contact Fixyourbody.com.

Company Name

Company Contact

Company Contact's E-mail Address:

Payment Authorization Officer:

Years In Business

Phone

Facility Address

Suite or P.O. Box

City

State
or Province (if outside U.S.A)

Postal(Zip) Code

Country

By clicking the submit button, your Registration Form will be processed and verified. A Customer Agreement Form will then be delivered to your E-mail address including your Customer Code. Once this is signed and returned to Fixyourbody.com, your account will be activated. Thank you for your business, please feel free to contact Fixyourbody.com to meet ANY needs that your company may require.

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