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ONLINE ORDER FORM

 

Please fill out the form below and will will contact you with the shipping details and final pricing.

AQUA MASSAGE SUPPLIES & PROMOTIONAL MATERIALS

Aquaseal â for barrier repairs
Aromatherapy Pad â felt pad with guard & magnet
Barrier Patch 12❠x 12â
Business Cards, Photo
Business Cards, Photo
Cleaner, Industrial Plastic â Polish for acrylic windows
Cleaner, Stainless Steel â Stainless steel cleaner / polish
Cotol (0.5 oz.) â Cleaner/accelerator for Aquaseal
Electrical Schematic
Face Paper, XL/HP/PT -1-24 rolls
Face Paper, XL/HP/PT - case (25 rolls)
Face Paper, Spa Model (100 sheets/pack), 1-9 packs
Manual, Operations â includes Schematic
Manual, Operations â includes Schematic
Manual, Technical Service â includes Operations Manual/Schematic
Manual, Technical Service â includes Operations Manual/Schematic
Standard Poster Set â two 11âx 17❠posters-one each Benefits Poster & Sales Promotion Poster
Water Treatment, Instant Ions Kit â includes water test kit & solution
Water Treatment, Instant Ions1 oz. bottle

NEW CUSTOMER / EXISTING CUSTOMER UPDATE INFORMATION:

Person Completing Form:
Prefix
First
Last
Suffix
Date:

MM
/
DD
/
YYYY
Owner Name:
Serial Number:
Business Name:
Serial Number:
Type of Business:
Serial Number:
Home Telephone Number:

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Business Telephone Number:

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Mobile Telephone Number:

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Email Address:
Billing Address:
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Delivery Address:
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Physical Address:
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country

MACHINE INFORMATION:

Unit From (prior customer #, Name):
Date Unit Obtained:
Hours on Unit:

SHIPPING INFORMATION:

Select Shipping Method:
 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) 
Is this a residence?
 YES 
 NO 

INTERNATIONAL ORDERS & SHIPPING:

For all international orders/shipping, please contact AMI directly via e-mail (sales@aquamassage.com) or telephone (860-536-3735).

PAYMENT INFORMATION:

Credit Card information will be requested when you are contacted by AMI with a complete quotation including shipping.

For orders less than $40.00, add an additional $15.00 handling charge.
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