Application Form

This is an order form. Please do not apply unless you are ready to purchase. Your package will be processed and invoiced.

Congratulations! You’re about to make the first step towards a successful business in the ever-popular practice of teeth whitening.

Now you’ve learned what TWA can offer, simply fill in the application form below, and we’ll get everything sorted for you.

If you need to contact us with questions before you order – please contact us through the Contact page on the website before filling in this order form.

Name

Phone number

Address

Why do you want to purchase a start-up package?

Current work/business situation

Business Name (if you have one)

Business address (if different from above)

YES, I have read through the Business Package web page fully and I understand the difference between the two machines, what the package includes, plus what bonuses are available. I understand the prices and the payment plans available.

Which machine?

Extras at 15% discount?

Boxed shade guide Secondary light for Ultra II Box of whitening toothpaste

Name of second person (if there is one)

Email of second person (if there is one)

How would you like to pay?

Where did you hear about us?

Yes, I've read and agree to the Terms and Conditions binding me to this contract.

IMPORTANT: Yes, I am ready to order and I understand this is my order form, and an invoice will follow. I will pay promptly to reserve my machine, and to start my training.

I am over 18 and have the funds available to pay my invoice within the stated terms on the invoice, so as to avoid any charges or fees.

Application Form

This is an order form. Please do not apply unless you are ready to purchase. Your package will be processed and invoiced.

If you need to contact us with questions before you order – please contact us through the Contact page on the website before filling in this order form.

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