Refer a friend
Or anyone you think may benefit from More Energy, Less Pain, and Faster Recovery!
Your name
First Name
Last Name
Your email
example@example.com
Your friend's name
First Name
Last Name
your friend's email
example@example.com
Back
Next
If they go on to purchase an APS Therapy machine, where shall we send the Thankyou?
I'd like to earn a £50 commission! ( We'll ask you how to pay you)
I'd like to gift my friend £50 off the price of an APS Therapy machine!
I'd like my £50 donation to go to our chosen charity, the Beds & Northants MS Therapy Centre
I'd like my £50 donation to go to the charity of my choice, below:
My chosen charity is:
blanks
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform