Wellness Directory Intake Form

Location

Address (Optional)

Business hours (Optional)
E-mail
Phone Number

Area Code Phone Number
Would you like to participate in a live Facebook interview?

Yes Please! No Thank You
Product Category - Please click all that apply

Accessories/Jewelry Books/Music Handmade Items Bath or Soap Products Beauty/ Natural Make up Products Candles Ceramics/Glass/Woodworking Children Focused Clothing Products Energy Healing Holistic Practitioner Healthy Living Psychic/ Medium Art/Paintings Health and Wellness Focused Mental Health Focused Food and Beveage
Business Tagline (If Available)
Short Description of Business (One Sentence Only)
Full Detailed Description of Business
Attach 3-5 photos of your products/business and your logo here:

Upload a File
Accepted file formats: GIF, JPG and PNG Cancel of
Social Pages
Blog:
Facebook Page:
Website:
Instagram:
Additional Comments/Questions:
If you have additional questions or comments, let us know here.
Prosperity Package

$150 Per Year
Full Name

First Name Last Name
Company Name

Location

E-mail
example@example.com
Phone Number

Area Code Phone Number
Product Category - Please select only THREE to FIVE that apply

Accessories/Jewelry Books/Music Handmade Items Bath or Soap Products Beauty/ Natural Make up Products Candles Ceramics/Glass/Woodworking Children Focused Clothing Products Energy Healing Holistic Practitioner Healthy Living Psychic/ Medium Art/Paintings Health and Wellness Focused Mental Health Focused Food and Beveage
Short Description (One Sentence Only)
Attach 1 photo of your products/business OR logo here:

Upload a File
Accepted file formats: GIF, JPG and PNG Cancel of
Social Pages
Website:
Instagram:
Facebook:
Blog:
Additional Comments/Questions:
If you have additional questions or comments, let us know here.
Bliss Package

$50 Per Year
Full Name

First Name Last Name
Company Name

Location

Short Description (One Sentence Only)
Product Category - Please select only ONE to THREE that apply

Accessories/Jewelry Books/Music Handmade Items Bath or Soap Products Beauty/ Natural Make up Products Candles Ceramics/Glass/Woodworking Children Focused Clothing Products Energy Healing Holistic Practitioner Healthy Living Psychic/ Medium Art/Paintings Health and Wellness Focused Mental Health Focused Food and Beveage
Website:
Additional Comments/Questions:
If you have additional questions or comments, let us know here.
Should be Empty:

Euphoria Package