Amjo HomePhotoTherapy Registration
Thanks for registering with Amjo. We pride ourselves on excellent customer service and when you complete the information below, we are able to serve you better.
Completion of this form will entitle you to a $50.00 discount on your first order with Amjo for orders over $1000.00.
As with other offers of this type, it cannot be combined with other discounts or incentives that Amjo may offer.
Your Name: *
eMail Address: *
Home Phone:
Work Phone:
Cell Phone:
Preferred Phone Number:
Home
Work
Cell
No Preference
Don't Call
Address (1) : *
Address (2) :
City: *
State: *
Postal Code / Zip: *
Disease/Skin Challenge:
Psoriasis
Vitiligo
Eczema
Other
Amount of body affected:
Comment/Question:
I am considering:
UVA
UVB Broadband
UVB Narrow Band
I don't know
Other
Please send me news that you believe will interest me:
Thanks Again:
When you click the button below, we will send you a confirming email. Let's hope you entered your email address correctly.
Regards
Chris Cane
President: Amjo Corp
PO Box 8304
West Chester, OH 45069
513-942-2770 (Tel)
513-942-2771 (Fax)
USA Toll Free: 1-877-BUY-AMJO
* = Input is required
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