New Applicant Information

First Name*

Middle Name

Last Name*

Suffix Choose... Dr. Mr. Mrs. Ms.

Date of birth*

Email Address*

Password*

SSN/Social Insurance # for Canadians

Amount of initial sale/transaction*

Home Phone*

Business/Work Phone*

Cell/Other Phone*

Current Home Street Address, where your new massage chair will be shipped to.*

Apartment

City*

State* Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming - Canadian Province - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon South Australia U.S. Virgin Islands

Zip*

Housing Status* Own Rent Other

Monthly Net Income*

Applicant ID Verification Information

Primary ID Type* Select Driver's License Government ID Green/Resident/Alient ID Military ID State Issued ID

Issuing State* Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming - Canadian Province - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon South Australia U.S. Virgin Islands

Exp. Date*

Secondary ID Credit Type* Select Credit Card Other

Issuer*

Exp. Date*

Product

Please select the chair you want. Medical Breakthrough 9™ Massage Chair Medical Breakthrough 6™ Massage Chair Medical Breakthrough 7™ Massage Chair Medical Breakthrough 5™ Massage Chair Medical Breakthrough 8™ Massage Chair Medical Breakthrough Full Body Pain Reliever™ Medical Breakthrough Leather Protection Massage Chair Cover Medical Breakthrough Podiatrist Medical Breakthrough Facial Relaxation Medical 3™ Sauna Medical 4™ Sauna Medical 5™ Sauna Medical Breakthrough 6 Plus™ Massage Chair Medical Breakthrough Custom Massage Chair™ Medical Breakthrough 8™ Plus Massage Chair - Open Feet Medical Breakthrough - Custom Padding™ Traditional 5 Sauna Traditional 6 Sauna Medical 6 Plus™ Sauna Medical Breakthrough 5™ - 5v2 Medical Breakthrough 4 - Massage Chair Medical Breakthrough 5™ Plus - 5v3 Medical 9 Plus™ Hybrid Sauna Vending 4 - Massage Chair Vending 5 - Massage Chair Vending 6 - Massage Chair Vending 7 - Massage Chair Vending 8 - Massage Chair Vending 9 - Massage Chair Hand-Crafted Custom-Built Sauna Medical 4 - Full Spectrum Sauna Medical 5 - Full Spectrum Sauna Medical 6 - Full Spectrum Sauna Medical 7 - Full Spectrum Sauna Medical 8 Plus v1 - Full Spectrum Sauna Medical Breakthrough 6 Massage Chair (ver 4.0) Healing 5 Healing 6 Healing 7 Healing 8 Medical Breakthrough 9 Plus™ Massage Chair Traditional 7 Sauna Traditional 8 Plus Traditional 9 Plus Medical Breakthrough 10™ Massage Chair Medical 8 Plus Version 2.0 Sauna Nature 5 - Hybrid - Outdoor Medical Sauna Nature 6 - Hybrid - Outdoor Medical Sauna Nature 7 - Hybrid - Outdoor Medical Sauna Nature 8 Plus - Hybrid - Outdoor Medical Sauna Nature 9 Plus - Hybrid - Outdoor Medical Sauna Medical Breakthrough Podiatrist Version 2.0 - Open Feet Rheumatologist 9 Plus- Lift Chair Rheumatologist 8 - Lift Chair Rheumatologist 7 - Lift Chair Rheumatologist 6 - Lift Chair Rheumatologist 5 - Lift Chair Perfect Chair 5 Perfect Chair 6 Perfect Chair 7 Perfect Chair 8 Perfect Chair 9 Pulmonologist 5 - Air Purifier Pulmonologist 6 - Air Purifier Pulmonologist 7 - Air Purifier Southern Ocean 8 - Air Purifier Southern Ocean 9 Plus - Air Purifier Icy Heat X-Large Clay Therapy Pack-in-a-Box™ Icy Heat Clay Therapy for Neck & Shoulders™ Icy Heat Full Body Clay Therapy Strap™ Medical Breakthrough 7 Plus™ Massage Chair Full Body Pain Reliever v2 Podiatrist Sleeve Podiatrist Sole Rabbit Heat Medical 3 Ver 2 - Sauna Medical 4 Ver 2 - Sauna Medical 5 Ver 2 - Sauna Medical 6 Plus Ver 2 - Sauna (2X) Two - Medical Breakthrough Podiatrist - SAVE $200 (2X) Two - Medical Breakthrough Podiatrist Ver 2.0 - SAVE $300 (2X) Medical Breakthrough 7™ Massage Chairs - Save $1000 (2X) Medical Breakthrough 8™ Massage Chairs - Save $2000 Focus Shed Medical Breakthrough 10™ Plus Massage Chair Version 2.0 Pulmonologist 4 - Air Purifier Nature 4 - Outdoor Medical Saunas Medical Breakthrough Leather Protection Blow Out Sale Medical Breakthrough4 Chair Cover Medical Breakthrough 5™ - 5v2 Medical Breakthrough 5™ Plus - 5v3 Chair Cover Medical Breakthrough 6 Plus™ Chair Cover Medical Breakthrough 7™ Chair Cover Medical Breakthrough 8™ Chair Cover Medical Breakthrough 8™ Plus Chair Cover Medical Breakthrough 9™ Chair Cover Medical Breakthrough 10™ Chair Cover Refurbish - Medical Breakthrough Podiatrist Refurbish - Medical Breakthrough Podiatrist Version 2.0 - Open Feet Medical 5v3 - ADA Complaint Medical 7v2 - Full Spectrum ADA Complaint Sauna Nature 7 - ADA Complaint Nature 5 - Outdoor Medical Saunas Nature 6 - Outdoor Medical Saunas Hybrid 6 Hybrid 7 Hybrid 8 ADA Hybrid 5 Wholesale 1 - Sauna Wholesale 2 - Sauna Wholesale 3 - Sauna Refurbish - Medical Breakthrough 10™ Plus Massage Chair Version 2.0 Refurbish - Medical Breakthrough 7 Plus™ Massage Chair Refurbish - Medical Breakthrough 8™ Plus Massage Chair - Open Feet Refurbish - Medical Breakthrough 6 Plus™ Massage Chair Refurbish - Medical Breakthrough 8™ Massage Chair Refurbish - Medical Breakthrough 5™ Massage Chair Refurbish - Medical Breakthrough 7™ Massage Chair Refurbish - Medical Breakthrough 9™ Massage Chair Traditional 4 Sauna Traditional 5 - 110 Volt Sauna Traditional 6 - 110 Volt Sauna Nature 8 Plus - Flat Roof Refurbish - Medical Breakthrough 6™ Massage Chair-Black Nature 8 Plusv2 - ADA Complaint + Removable Bench Refurbish - Medical Breakthrough 6 Refrubish Medical Breakthrough 5™ - 5v2 Refurbush Medical Breakthrough 5™ Plus - 5v3 Refurbish - Medical Breakthrough 7 Plus™ Massage Chair Touchscreen - Indoor 5 Touchscreen - Indoor 6 Touchscreen - Indoor 7 Touchscreen - Indoor - 8 Plus Medical Breakthrough 10™ Plus Massage Chair Version 3.0 Refurbish - Medical Breakthrough 10™ Plus Massage Chair v1 Refurbish - Medical Breakthrough 10™ Plus Massage Chair Version 3.0 Frozen Cold Plunge Frozen Cold Plunge + Fushion Steamer Frozen Cold Plunge + Fushion Steamer + Accessories Kit The Resort Sauna The Resort Sauna + Frozen Cold Plunge + Medical Hot Springs The Resort Sauna + Frozen Cold Plunge + Medical Hot Springs + Walking Dressing Room Medical 6 ™ - Version 2.0 Sauna Medical 7 Plus™ - Version 2.0 Sauna Massage Chair - Don't know which one they want, wants more detail Sauna - Don't know which one they want, wants more detail

Joint Application

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First Name*

Middle Name

Last Name*

Suffix Choose... Dr. Mr. Mrs. Ms.

Date of birth*

Email Address*

SSN*

Amount of initial sale/transaction*

Home Phone*

Business/Work Phone*

Cell/Other Phone*

Current Home Street Address*

Apartment

City*

State* Select AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AA AE AP GU PR VI AS MP MH KG MM SS SW FM PW

Zip*

Housing Status* Own Rent Other

Monthly Net Income*

Applicant ID Verification Information

Primary ID Type* Select Driver's License Government ID Green/Resident/Alient ID Military ID State Issued ID

Issuing State* Select AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AA AE AP GU PR VI AS MP MH KG MM SS SW FM PW

Exp. Date*

Secondary ID Credit Type* Select Credit Card Other

Issuer*

Exp. Date*

Your Signature

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I agree to the Medical BreakThrough Terms & Conditions. If you are approved, you'll get your new massage chair in less than 2 weeks.