VitaShots Mobile Business Registration Form

Register Your Business to become a Business Host for VitaShots Mobile

Please provide all required details to register your business with us to be placed on the waiting list for your area. Registration does not guaranteed a clinic. All Business Host agree to host a weekly or bi weekly clinic with VitaShots Mobile Shot Clinic to administer vitamin and/or Amino acid injections to the public in exchange for FREE HOST/HOSTESS injections each clinic & Facebook advertising our clinic in your business to drive in traffic at no cost to you. We love to cross-promote with our business host when we can, and help drive traffic into your business for potential sales for you.
Start HERE

Please provide Business Owner Name and contact information. ( We do not share this information - this is just to verify we have permission from the right person and to send occasional gifts from us)
Business Owner *

First Name Last Name
Business Owner Phone Number
Please enter a valid phone number.
Who will be our main contact person?

This will be someone that we can communicate with in case of delays or clinic closures.
Person to contact for updates or changes to clinic times.

First Name Last Name
Person to Contact Number *
Person to Contact Email
example@example.com
Tell us about your Business

These details will be used in marketing efforts. We do not give out any information other than post the address and business name on marketing.
Business Name *
Business phone number *
Please enter a valid phone number.
Business E-mail *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
We use Facebook for our main source of advertising. If we are able to tag your FB page and add you as a HOST to our events, this could help both of our businesses reach more people.

Please make sure your FB page like is included so we know we have the right business :)
FaceBook Link to your business Page
Website for you Business
Type of Business *
Others *
Why do you want to become a business host/hostess? If you have anything additional you would like to ad, please do so.
Please show us your Business in Pictures

These pictures can be uploaded here or emailed to vitashotsmobile@gmail.com
Upload Store Front Picture. The Front of the Outside of your business that we can use for advertising.

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Upload 1 picture to showcase the inside of your business

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Add your company logo that we can use for advertising

function SvgDhtupload(props) { return /* @__PURE__ */ react.createElement("svg", dhtupload_svg_extends({ width: 54, height: 47, xmlns: "http://www.w3.org/2000/svg" }, props), dhtupload_svg_path || (dhtupload_svg_path = /* @__PURE__ */ react.createElement("path", { d: "M40.213 10.172c1.897.21 3.68.738 5.35 1.58a15.748 15.748 0 014.374 3.242 15.065 15.065 0 012.951 4.533c.72 1.704 1.08 3.522 1.08 5.455 0 1.827-.28 3.654-.843 5.48-.562 1.828-1.379 3.47-2.45 4.929A13.39 13.39 0 0146.669 39c-1.599.948-3.452 1.458-5.56 1.528H37.26a1.62 1.62 0 01-1.185-.5 1.62 1.62 0 01-.501-1.186c0-.457.167-.852.5-1.186.334-.334.73-.5 1.186-.5h3.848c1.44 0 2.75-.37 3.926-1.108a10.851 10.851 0 003.03-2.846 13.53 13.53 0 001.95-3.9 14.23 14.23 0 00.686-4.321c0-1.582-.316-3.066-.949-4.454a11.623 11.623 0 00-2.582-3.636 12.857 12.857 0 00-3.742-2.478 11.054 11.054 0 00-4.48-.922l-1.212-.053-.37-1.159c-.878-2.81-2.292-4.998-4.242-6.562-1.95-1.563-4.594-2.345-7.932-2.345-2.108 0-4.005.36-5.692 1.08-1.686.72-3.136 1.722-4.348 3.005-1.212 1.282-2.143 2.81-2.793 4.585-.65 1.774-.975 3.68-.975 5.718h.053l.105 1.581-1.528.264c-1.863.316-3.444 1.317-4.744 3.004-1.3 1.686-1.95 3.584-1.95 5.692 0 2.39.8 4.462 2.398 6.219 1.599 1.757 3.488 2.635 5.666 2.635h4.849c.492 0 .896.167 1.212.5.316.335.474.73.474 1.187 0 .456-.158.852-.474 1.185-.316.334-.72.501-1.212.501h-4.849a10.08 10.08 0 01-4.374-.975 11.673 11.673 0 01-3.61-2.661 13.173 13.173 0 01-2.478-3.9A12.073 12.073 0 010 28.301c0-2.706.755-5.148 2.266-7.326 1.511-2.178 3.444-3.636 5.798-4.374.14-2.354.658-4.542 1.554-6.562.896-2.02 2.091-3.777 3.584-5.27 1.494-1.494 3.25-2.662 5.27-3.505C20.493.422 22.733 0 25.193 0c1.898 0 3.637.237 5.218.711 1.581.475 3.004 1.151 4.269 2.03a13.518 13.518 0 013.268 3.215 18.628 18.628 0 012.266 4.216zm-11.964 13.44l6.22 6.85c.245.247.368.537.368.87 0 .334-.123.642-.369.923l-.421.263c-.211.246-.484.343-.817.29a1.544 1.544 0 01-.87-.448l-3.69-4.11v16.97c0 .492-.166.896-.5 1.212-.334.316-.729.474-1.186.474-.492 0-.896-.158-1.212-.474-.316-.316-.474-.72-.474-1.212V28.25l-3.584 4.005a1.544 1.544 0 01-.87.448.959.959 0 01-.87-.29l-.42-.264c-.247-.28-.37-.588-.37-.922 0-.334.123-.624.37-.87l6.113-6.746v-.052l.421-.422a.804.804 0 01.396-.29c.158-.053.307-.079.448-.079.175 0 .333.026.474.079.14.053.281.15.422.29l.421.422v.052z", fill: "none" }))); }

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How did you hear about becoming a VitaShots Mobile Host/Hostess?
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Register Your Business to become a Business Host for VitaShots Mobile

Start HERE

Who will be our main contact person?

Tell us about your Business

We use Facebook for our main source of advertising. If we are able to tag your FB page and add you as a HOST to our events, this could help both of our businesses reach more people.

Please show us your Business in Pictures