Sample Request


Welcome to the Biofreeze® Build Your Practice Sign-Up page. 

To receive your complimentary customized marketing materials, please complete the information below.
 
Required fields are in red.
Contact Information:
First Name:
Last Name:
Title:
Email:
Discipline:
 
Practice Information:
Practice Name: (This field will be used for "Customized" printing orders.)
Shipping Address: (No P.O. Boxes.)
Suite / Unit #:
City:
State:
Zip:
Phone: (This field will be used for "Customized" printing orders)  
Fax:    
Website:
Patients Per Month:
Practitioners on Staff:
 
Retail Information:
Do You Sell Biofreeze?:
Your MAIN Distributor:
  # of Units Sold per Month Your Retail Price per Unit
2 fl. oz. Spray:    
4 fl. oz. Spray:    
16 fl. oz. Gel Pump:    
3 fl. oz. Roll-On:    
4 fl. oz. Gel Tube:    
4 fl. oz. Gel Tube
with Applicator Tip:    
8mL Single Use
Wipes (24/Box):    
 
Do you need marketing material for your practice, then fill out this section.
If you need samples for an event, then you should use the Event Marketing Form.
Marketing Support:
 
SAMPLE CARDS
Customized (with sample) [Preview]
Customized (with sample) [Preview]
PRODUCT BROCHURES
Customized (no sample) [Preview]
Customized (no sample) [Preview]
IN CLINIC MARKETING
Countertop Display [Preview]
Window Decal [Preview]
LOGIN TO ORDER OUR PERFORMANCE PERKS PROGRAM ITEMS
Massage Manual [Preview]
Patient Education Video [Preview]
 
Comment:
 
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