Refer A Smoker

Referral a Smoker

We sincerely appreciate any referrals to us for the E-cigarette healthy alternative to smoking tobacco. When someone you refer to us using this form becomes a customer, we will send you a free Gift Card to Amazon.com. Thank you for helping us help your friends, family members and co-workers.

Please use this form to refer others to us.
We respect your privacy and the privacy of
those you refer to us.

Your Name *

First

Last

Your Email *

Your Phone number & best time to call *

Name of your Referral *

Phone number of your Referral and best time to call *

Email address of your Referral *

Please check all that apply -- Smokers may need more than E-cigarettes *

Comment(s) questions, other helpful info *

Submit

Referral a Smoker

Please use this form to refer others to us. We respect your privacy and the privacy of those you refer to us.

Please use this form to refer others to us.
We respect your privacy and the privacy of
those you refer to us.