Mind Body Matrix Marketplace Sign-Up Form
Basic Information
Company Name
*
Website URL
*
Industry/Category
*
Health & Wellness Products
Fitness
Nutrition
Technology
Mental Health
Regenerative Medicine
Other
Year Established
*
Location
*
Headquarters
Primary Contact Name
*
First Name
Last Name
Position/Title
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Product and Service Details
Product/Service Overview
Brief Description of Your Products/Services - 250-word limit
Number of Products/Services You Plan to List
Please Select
1-5
6-10
11-20
21+
Primary Benefits of Your Products/Services
Enhances Wellness
Supports Mental Health
Promotes Physical Fitness
Innovative Technology
Regenerative Treatments
Other
Upload Product Images or Brochures
Browse Files
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Choose a file
File upload option for up to 5 files; JPG, PNG, PDF formats
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What Sets Your Brand Apart?
Your Unique Selling Proposition (USP)
Marketplace Fit and Alignment
How Does Your Brand Align with Our Mission?
200-word limit; prompt to explain alignment with wellness, innovation, and community impact
Are You Willing to Contribute a Portion of Sales to Supported Causes?
Yes
No
Preferred Cause(s) to Support
Veterans
Orphaned Children
Cancer Research
Muscular Dystrophy
Athletes
Other
Who Is Your Primary Audience?
General Consumers
Athletes
Wellness Professionals
Medical Practitioners
Families
Other
Regions You Currently Serve
North America
Europe
Asia
Global
Other
Marketing and Engagement
How Do You Currently Market Your Products?
Please Select
Social Media
Influencer Marketing
Email Campaigns
Retails
Events
Other
Instagram Handle
Facebook Page
LinkedIn Profile
Other Relevant Links
Upload Recent Marketing Materials or Campaign Examples
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File upload option; PDF, JPG, PNG formats
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Are You Interested in Co-Creating Educational Content with HermesLongevity Educators?
Yes
No
Are You Open to Being Featured in Live Shopping Events on EyeOn Channel?
Yes
No
Performance and Analytics
Average Monthly Sales
Please Select
$10,000
$10,000-$50,000
$50,000-$100,000
$100,000+
Current Conversion Rate (if applicable)
Input field as a percentage
Top Sales Channels
Direct to Consumer
Online Retailers
Clinics/Practitioners
Wholesale
Other
Technical Integration
Does Your Product Require Special Setup or Integration? (e.g., Subscription Management, IoT Devices
Yes
No
Are You Able to Provide Product Demos or Trials?
Yes
No
Legal and Compliance
Do You Have Necessary Licenses and Certifications to Sell Your Products?
Yes
No
Upload Relevant Certifications (e.g., FDA, CE, ISO)
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Are You Able to Comply with Marketplace Policies on Data Privacy and Consumer Safety?
Yes
No
Final Steps and Submission
Is There Anything Else We Should Know About Your Brand?
Submit
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