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.
Business Owner
*
First Name
Last Name
Business Owner Phone Number
Please enter a valid phone number.
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
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
FaceBook Link to your business Page
Website for you Business
Type of Business
*
Please Select
RETAIL STORE
BOUTIQUE
SPA OR SALON
HEALTH STORE
Others, please specify below.
Others
*
Any other questions or comments add here.
Upload Store Front Picture. The Front of the Outside of your business that we can use for advertising.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload 1 picture to showcase the inside of your business
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Add your company logo that we can use for advertising
Browse Files
Drag and drop files here
Choose a file
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of
Signature
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Save
Submit Registration
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