Kapitex Facemask and PHONIQ Product Trial

Try the PHONIQ® products for yourself by enrolling in our 7 day free of charge product evaluation. Please fill out your contact details below and we will write to you by post or email with details of how to take part. All those who register to try the PHONIQ® products will receive TWO FREE Kapitex Branded face covers for you and a friend or family member.

You do not have to participate in the product evaluation, to take advantage of this offer. Tick the box below which applies:

Question Title

* 1. I would like more information about the PHONIQ® 7 day product evaluation please contact me using the details below.

YES

Question Title

* 2. I would like to receive a free Kapitex face cover for myself and a friend / family member.

Yes

Question Title

* 3. If you would like to be kept up-to-date about products and services from Kapitex Healthcare please tick the box below. You may opt out at any time by contacting us by email, phone or text.

Yes I would like to receive information

No I would not like to receive information

Question Title

* 4. Your Contact Details

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address