Your Information:

Your First Name *

Your Last Name *

Your Phone *

Your Email *

Referral Information:

Please enter the information for the person you are referring to us below.

First Name *

Last Name *

Phone *

Email *

Other:

Communication Preferences:

Account Messages: By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Marketing Messages: By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Important!

Once you submit this form, you will receive a copy to the email address you provided above. Please forward the email or send a screenshot of the email to the person you have just referred above. They can then present that to us at the time of purchase, and both of you will receive a Loyalty Points Bonus for participating in our Referral Program!

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