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massage therapist contractor application
Once you've submitted the form below, please send the following documents via fax: (866) 715-7465
  • A copy of your Liability Insurance Policy
  • A copy of your Massage License
  • A copy of your Business Card
 
First Name:

 Last Name:
Street Address:
 City:
State:
 Zip Code:
 Nearest Metro Area:
Home Phone :
 Mobile Phone:
E-Mail Address:
 
 

Insurance & Licensing
Liability Insurance Provider
Massage License
Liability Insurance Policy #
License Number
Liability Insurance Exp Date
 License Exp. Date
 

Professional References
Reference #1 Name:

Phone Number:

Relationship:


Reference #2 Name: Phone Number: Relationship:
 

miscellaneous
How many hours of massage training have you had?
Have you had specific training in chair massage?
How many years have you been practicing massage?
Do you own a professional massage chair?
Which Brand and Model?
   
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