Customer Update Form

Are you an existing Weight-By-Date customer and need to update your contact information?  Please fill in the following fields and we will update our records.

First Name:
Last Name:
Current Mailing   Address:
Current E-Mail:
Old Mailing Address   (if different):   Please help us locate you in   our records by listing the old   address that we might have   on file for you. If you have   moved more than once, please   list any additional addresses.
Old E-Mail Addresses:   Please help us locate you in   our records by listing any old   e-mail addresses that we   might have on file for you.
Do you want us to notify you via e-mail when a free program update has become available for download?
Do you want us to notify you via e-mail when we have special offers or discounts with our products?
Do you want to subscribe to the Weight-By-Date Newsletter (sent via e-mail monthly)?
A Note About Your Privacy: Notifications are made via e-mail and you will only receive these e-mails from us (Quite Healthy Technologies).  We WILL NOT -- under any circumstances -- give your contact information to anyone else.

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Quite Healthy Technologies is located at: 5448 Apex Peakway #303, Apex, NC  27502
Copyright © 2008 Quite Healthy Technologies, a Division of ProVariant, Inc.  All rights reserved.
 
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