Fill out below form and submit it to Biologix within 10 days after the referred new customer has placed their first order. The $15 gift card will be mailed within one week after the referral is verified.
1.) Contact Information. Please include the mailing address of where you
would like the gift card sent.
Name of Organization:
Name (First, Last):
Email:
Mailing Address:
City:
State:
Zip code:
Biologix Account Number
(What's This?)
Biologix Account number consists of one letter and four numbers and can be found on your previous invoices or packing slips. If you're unsure what your account number is please call us toll free at 1-866-580-2549 and a customer respresentative will assist you.
Account #:
2.) New Customer Referral Information
Name of Organization:
Contact Name (First, Last):
Order Date:
