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WELCOME TO THE EEQUBE REFERRAL ORDER FORM

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This order form is intended for individuals who were referred by a public EESystem center and are interested in purchasing an EEQube for themselves.

This helps us gather the correct details to accurately proceed with your order.

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Referral Code ^*

Enter the referral code provided to you by the center.

It should start with "EES" followed by 3 numbers.

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Color & Quantity

Your choice of black or white EEQube, as well as the number of EEQube's you'd like to order can be discussed via email or phone.

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Enter the EEQube location ^*

Please be as specific as possible. For example, this would be your home address where the EEQube will be setup.

Address

Address line 2

City ^*

State / Province

Zip / Postal Code

Country ^*

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How many signatories will be signing? ^*

⚠️ Our agreement contains spaces for 1-4 signatories/partners.

1 (Just Me)

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Signatory 1 (You) Details ^*

⚠️ This must be a legal name. No nicknames.

The email and phone number provided here will be your primary email and phone number on your file for correspondance.

First Name ^*

Last Name ^*

Email ^*

Phone Number ^*

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Signatory 2 Details ^*

⚠️ This must be a legal name. No nicknames.

First Name ^*

Last Name ^*

Email ^*

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Signatory 3 Details ^*

⚠️ This must be a legal name. No nicknames.

First Name ^*

Last Name ^*

Email ^*

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Signatory 4 Details ^*

⚠️ This must be a legal name. No nicknames.

First Name ^*

Last Name ^*

Email ^*

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Company Name

If you have a company name you would like to be listed on the license agreement and invoice, please provide below.

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📩 WATCH YOUR JUNK FOLDER

Please watch your junk folder as some applicants report not receiving our responses, agreements to sign, and invoices as they go to their junk folders.

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Your EEQube Order Has Been Submitted, ___!

You should receive an email or phone call in the next 1-3 business days.

Welcome back! Loading your previous answers...

WELCOME TO THE EEQUBE REFERRAL ORDER FORM

This order form is intended for individuals who were referred by a public EESystem center and are interested in purchasing an EEQube for themselves.

Color &amp; Quantity

📩 WATCH YOUR JUNK FOLDER

Your EEQube Order Has Been Submitted, ___!

Color & Quantity