Bucking Bull Inquiry

Greetings!

Thanks for your interest in an EquiPulse PEMF Device. We need more information about you, so please fill out and submit this form!
Notes
Your Name*

First NameLast Name
Your Phone Number*

Area CodePhone Number
E-mail*
Your Address (optional)

Street Address

Street Address Line 2

CityState

Zip Code
Employing PEMF Technology*

to treat my own animals onlyto use in an already established businessto start an PEMF Therapy PracticeOther - Please describe
Will you need to Finance your purchase?*

YesNo
I discovered the family of EquiPulse branded PEMF devices [select all that are applicable ]:

Online SearchI have contacted a Company Rep in the USAFaceBook and/or InstagramOther Social MediaYouTube or other videositesAn Email Campaign
USA Sales Representative or Brand Ambassador I have already communicated with directly or through a social media post
I am interested in PEMF Technology for *

Bucking BullsLivestockShow CowsEquineSmall AnimalsSea MammalsExotic AnimalsHumansOther
Other uses
I am interested in acquiring one of the following PEMF Devices

Magnus Pro X1 HPMagnus Pro X2 MPMagnus Pro X1 MPI need more information before deciding
It is important that

A PEMF Device has received an Electrical Safety Testing Certificate ( CE Mark or UL)The manufacturer protects its buyers and users with a Product Liability PolicyIs FEI Compliant (generates less than 1,000 Gauss maximum output)None of the above is important
I am a Licensed Medical Professional*

YesNo
Check the days of the week in the next 5 days you are available to talk on phone*

MondayTuesdayWednesdayThursdayFridaySaturday
Select a Time of Day (Must be Eastern)
Your Time Zone*

PacificMountainCentralEastern
Referral Notes
Any other questions or considerations we need to know about?
Submission Date*

MonthDayYearHourMinutesAM/PM Option
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