Liquid Lipo Stockist info
This form will be used to collate your details for clients to find you through the new website
Website Data Collation
Please accept our apology if you have already submitted these details. Please could you fill this form in, even if previously submitted data. This data will be used to input on to a map whereby potential clients can search their postcode and find their nearest stockist. By completing this form, you agree to data being shared with the public on a website that is available to anyone. Should you wish not to be included in the website database, please contact mdavies86@hotmail.co.uk. The deadline to have all data submitted is 12th March 2021, should you not provide these details, you will unfortunately not be included on the website until the next refresh. Kind Regards, Liquid Lipo HQ
Salon Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Salon/Clinic Name
*
Name
*
First Name
Last Name
Work Phone Number (Inc Area Code, EG +447413580611)
Business Website (e.g. www.mysite.com or www.facebook.com/mysitedetails
*
Salon Email
*
example@example.com
Treatments Offered
*
Top Tip: Type into a word document and spell check, then paste into this field. This will ensure that no spelling mistakes occur. Separate each treatment with a comma. E.G. Liquid Lipo with cavitation, Facials, Hair Extensions.
Submit
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