1. Name: *
2. Company Name: *
3. Contact Phone *
4. Contact Email *
5. Address *
Voucher Information
6. Number of vouchers *
7. Voucher amount $ *
8. Total $ *
9. Products on Site (select one): Activity Trackers (i.e. Fitbit, Garmin, Polar)All Health and Wellness ProductsSingle brand/ProductOther
If you selected "Single brand/Product" or "Other" please specify here
10. Voucher codes (select one) designated codes i.e. employee ID or email addresses – if chosen please email an Excel file with designated codes to [email protected]randomly issued codes by iRedeem

25% of the total voucher order is due at the time of ordering; the balance to be paid upon redemption of the vouchers, to be billed monthly.

Payment can be made by check to Harmony Equities LLC and mailed to PO Box 1030, Brick, NJ 08723.

Account Name: Harmony Equities, LLC

Address: PO Box 1030, Brick, NJ 08723

>Bank Name: Investors Bank

Address: 425 Rt.70, Lakewood, NJ 08701

732-886-0526

ABA: 221272031

Account: 1000805640

* Required