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Refer a Colleague 
Earn Their Appreciation
Let Us Show Ours...

Refer Friend, colleague or facility to E-Rehab Docs.... It they purchase you earn their appreciation..  We will show you ours... Select from great stuff below. 

(You must be the first to refer or recommend us to the prospective client / facility)

  • Select one prize for each of your referrals that purchase E-RehabDocs.

    Apple IPod / ITouch
     Sony PSP (Personal Play Station)
     Cash (20% of any sale)
     Elo Touch Screen Monitor 17 inch.
     Cannon Digital Camera
     DVD Player / Recorder

  • Please provide the following contact information: (Your Personal Info - For payment - referral tracking)
    Your Name
    Your Title
    Organization
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Work Phone
    FAX
    E-mail

 

  • Please provide the following contact information:
    Name
    Title
    Organization
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Work Phone
    FAX
    E-mail

     

  • Please provide the following contact information (second contact if any):
    Name
    Title
    Organization
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Work Phone
    FAX
    E-mail

     

  • Please provide the following contact information: (3rd Contact if any)
    Name
    Title
    Organization
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Work Phone
    FAX
    E-mail

     

  • Any Comments Regarding Referrals or Our Product..

    Do you like the product / endorse it.  Do you mind if we use your name when we contact your referrals?


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Revised: 04/23/08
 
Copyrights © 1989-2006 RSS / Synergy. All Rights Reserved.