Special Pricing

To receive your special pricing and free quote, complete the following:

1.	What is your occupation?
		If you are a clinician, please give license # here
2.	Which model are you interested in?
3.	Are you an IndeFree member? (attended a course prior)	Yes No
4.	Which payment method will you be using?
5.	What is your shipping address?
6.	Which marketing items are you interested in receiving for free?	Poster (view sample) Brochures (view sample) Postcards (view sample) The 830Laser Exclusive Training Manual
7.	Have you already received any quotes?	Yes No
If yes, from whom? Fax a copy of the quote to us at (866) 319-7682.
8.	When are you planning on making this purchase?	(specific date required)

	Your name
	Best phone # to reach you
	Email
	Comments:

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