iLight IPL Pro and LED Pro deposit form
Contact Name
*
First Name
Last Name
Phone Number
*
Email Address
*
example@example.com
Shipping Address and business information
Business Name (For sales invoice)
*
Name of contact that will coordinate delivery and training
*
First Name
Last Name
Phone Number for coordinating delivery and training
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Closest Airport to Office
How do you plan on paying for your device(s)
*
Please Select
Pay with check or bank transfer
Finance
Pay by credit card (3.5% convenience fee)
Payment is due 3 s
How soon do you want the machine(s) delivered
*
Please Select
As soon as possible
1-3 months
3+ months
Anything else you would like to share with us
Payment by Credit Card or Paypal
Deposit
*
prev
next
( X )
iLight IPL Pro + RF Deposit
This deposit will hold your iLight IPL device and will be put towards your total price. Must bring in device in 2023 for savings.
$
500.00
Quantity
iLight LED Pro
This deposit will hold your iLight LED Pro device and will be put towards your total price. LED Pro Includes both a head of pure red light and a head with 4 colors (blue, yellow, red, infrared). Must bring in device in 2023 for savings.
$
500.00
Quantity
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Save
Submit
Should be Empty: