First Name:

Last Name:

Address:

City:

State:

ZIP:

Home Phone:

Alternative Phone:

Best Time To Reach:

E-Mail:

Why do you want to become an Authorized Z-CoiL retailer?

I own a pair and believe in the product.

I know someone who owns a pair, and I believe in the product.

Other

I understand in order to become an Authorized Z-CoiL retailer I will need liquid capital of approximately $85,150 to $160,800, depending on my local market and other variables. (Based on Albuquerque, New Mexico cost-of-living estimates.)

I understand in order to become an Authorized Z-CoiL retailer, I will need to open a dedicated Z-CoiL Pain Relief Footwear retail store having a minimum of 1,000 square feet.

How long have you been looking to start a business?   

If you have a location in mind, what is its city and ZIP code?
    City      ZIP

How did you first become interested in the Z-CoiL retailer opportunity?   (Please select your primary source.)

Z-CoiL BizBuzz Newsletter

Footwear Plus MarketPlace

News Story:

Franchising Guide for Military Veterans

Trade Show/Public Event:

Social media website:

I own a pair of Z-CoiL footwear

Z-CoiL Distributor

Z-CoiL Website

I know a Z-CoiL customer

Other:

Application Statement It is understood that the purpose of this pre-application is for information only, and is no way binding upon either the applicant, or Z-Tech, Inc. dba Z-CoiL Footwear. The information I have submitted within this request for information is true and complete to the best of my knowledge and belief.

By selecting AGREE, I agree to the above statement and release Z-Tech, Inc. dba Z-CoiL Footwear from all liability.

AGREE DISAGREE