Wellness Network Registration
A Thank you Gift, valued at above $500, for being part of the Soulsational Family. Membership expires 1 2018.
Todays Date
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Name of Business:
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Website:
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Physical Business Address:
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Phone Number:
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E-mail:
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Facebook Page URL
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Etsy Page URL
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Short Description, 3 - 5 sentences
About the owner/business: owner: a little paragraph about you, your background, what you love about your job, etc business: how long you’ve been in business, how it got started, any special features, what makes you stand out, why do your customers/clients love you? Etc. Products offered: Product, brief description Ex: Vitamins, We offer a wide array of vitamins including B12, C, E, etc etc. List broad products like "organic food", and then give some examples and/or brands as the description. Services offered: List in the same format as "products offered" Service, brief description. Mission statement.
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Discounted Rate to Members of the Wellness Network
Ex: 10% off your entire purchase every time you shop!
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Photo to go with your listing: A photo of yourself or your business. Acceptable formats: jpg, gif, bmp, tiff, psd. Email all of this information to MichelleLeonardDirector@gmail.com
Wellness Provider Acceptance Agreement: This is a binding contract between the Wellness Network, A division of Alternative Health Solutions of NJ, and Myself. By electronically signing this agreement you are agreeing to become a “Provider” of the Wellness Network, “Wellness Provider Network”. This contract is valid for the duration of one year. During the contract term, you agree to 1) provide products and/or services at a discount from your normal rates equal to the “Discounted Rate” you set up with the Wellness Network to card holding members of our discount network, when they present a discount card issued by the Wellness Network. You agree to 2) not offer the same discounted rate to the public. You agree to 3) provide your products and/or services with a minimum discount of 10% off your normal rate or as described above to members of the network at all times unless otherwise agreed to by the Wellness Network. You agree to 4) give the same level of service to our “Discount Card Members” and not give other clients or customers preferential treatment including but not limited to appointment availability. You agree to 5) maintain an updated listing/profile on our website during the contract period and provide us with updated contact and business information if you move your place of business, change the name under which you do business, or change any other major aspect of the services or products you provide. As a Provider, if the service or product you provide is licensed by the city, state, or federal government, you agree to maintain current licensure and maintain the minimum necessary insurance if applicable to your product or trade. If you collect and/or maintain records that contain health information you agree to keep that information private in a manner according to the current laws set out by the HIPAA. You agree to be held liable for any claims that are a result of your failure to maintain licensure or follow any laws applicable to the product or services you provide. You agree not to hold the Wellness Network liable for any damages caused by our discount card members, any “Provider” in our network, or any other party we do business with. The discount card member is ultimately responsible for payment to you as a “ Provider”. You agree as a “Provider” not to hold the Wellness Network, or any party we do business with, liable for any balances due by the discount card member. It is your responsibility to verify the authenticity of the discount card, match the name on the card with your client’s name, and adhere to any expiration dates posted on the card. You agree to take full legal responsibility for any information you provide. Failure to adhere to the terms of this contract may result in early termination from the Wellness Network. I have read and understand. This is my Electronic Signature.
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