Gaiam Holiday Gifts
   
   
   
       
   


Order Form for Enhanced Listing

All fields required unless otherwise noted

  Contact Information
Title:
First Name:
Last Name:
Address 1:
Address 2:
City:
State/Province:
Required for US and Canadian addresses only.
ZIP:
Phone:
E-Mail:
Country:
   
  Spa Information
Spa Name: If you are updating an existing listing, please select from the drop-down below:
or enter your Spa Name:
Website (optional):
Category:
(Select all
that apply)
Day SpaAyurvedaResort/Hotel
YogaDetoxDestination Spa
FitnessMedical SpaEco-Friendly
SpiritualitySponsored SpaMother/Daughter
Weight LossNutritionPre-post Natal
Spa Description:
Please write up to 200 words including a description of the spa, focusing on the atmosphere, signature treatments, unique programs, or anything else you feel separates your property/spa experience from others.
Accommodations:
Please write up to 100 words.
Dining:
Please write up to 100 words.
Spa & Salon Services:
Please write up to 100 words.
Health & Fitness:
Please write up to 100 words.
Attach JPEG of Spa Photo:
(Photo specs: RGB, square image, maximum 500 pixels wide, 72 dpi)
 
 Payment Information
  Please choose:
Charge my credit card - $950
Bill me one time - $950
Bill me $79.17 per month
Other Amount (Requires prior approval)
 
  Billing Address
Address 1:
Address 2:
City:
State/Province:
Required for US and Canadian addresses only.
ZIP:
 
  Credit Card information (required only if first option above is selected)
Full Name on Card:
Credit Card:
Credit Card Number:
CVV2:  
Expiration Date: /


Please hit the submit button only once.
This form may take a few moments to process.

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