Distributor order form

Complete the form with as much information you can and one of the team will be in touch.

Sales Representative Name *

Sales Representative Email *

Legal Entity Name *

Address *

Country *

State *

Postcode * Zip Code * Zip Code *

Trading Name

City *

Primary Contact name *

Primary Contact Email *

Primary Contact Title *

Name *

Email *

Number of Virtual devices *

Annual fee charged to customer *

Your purchase order number *

Minimum commitment period *

Initial Billing Date *

Upload a pdf copy of your purchase order

GX Program Bundle Cycle Program Bundle

BODYPUMP® Virtual
BODYCOMBAT® Virtual
BODYFLOW® Virtual
CXWORX® Virtual
LES MILLS GRIT® Virtual

BODYPUMP® Virtual
BODYCOMBAT® Virtual
BODYFLOW® Virtual
RPM® Virtual
LES MILLS SPRINT® Virtual

By submitting this form, you accept the Terms and Conditions