Tanning Salon Equipment Lotion Information Request Form

(* - designates required field)

Contact Name: * A value is required.

E-mail Address: * A value is required.Invalid format.

Phone: * A value is required.Invalid format.

Fax: Invalid format.

Street Address: * A value is required.

City: * A value is required.

State: * A value is required. Zip: * A value is required.

Salon Name:

Your Title:

Please complete the following questions:

Are you planning on buying any equipment in the near future?	Yes No
If yes, when?
What type of business is this for?
Is this a new or existing business?	New Existing
If this is for a new business, have you selected a location?	Yes No
If this is for an existing business, how many beds do you have?
How did you first learn about Tan and Health Supply, Inc.?
Please include applicable name for above question:
What Make of equipment would you like us to offer Reconditioned?
And of that Make, what Model would you prefer?

Additional Comments