Contact Us
     
 

Yes, I want to find out more about Wellness Jackpot and get my FREE sample kit!
SIMPLY FILL OUT THIS FORM OR CALL 800-806-0790.The Peavey Corporation
For additional inquiries, email us at info@wellnessjackpot.com .

*Required fields are indicated by an asterisk.
How did you hear about us?
 
Print Ad | *Source Code:
Direct Mail | *Source Code:
*Enter Source Code, located in the lower corner, from piece for automatic entry to win a FREE iPod nano!  (Source code consists of letters/numbers, i.e. ADCSOLW1/07)
Internet Search  
Referral
Other:
Tell us who you are.
 
*Name:
Title:
 
*Company:
 
*Address:
 
*City:
*State:
*Zipcode:
 
 
*Email:
*Phone:
Tell us about your company.
  SIC Code:   *Number of Employees:
 
Incentive Needs: Immediate   3-6 Months   Future
 
Purchase Decision Made by : Self   Committee   HR Manager  
 
We have a wellness program in place currently:
  Yes   No   Current program   Cost
 
If yes, are you looking for more participation Yes   No  
 
We offer a Health Risk Assessment to our Employees Yes   No  
 
Is your company Self-Insured    Fully-Insured  
What are you interested in – Check all that apply.
  A FREE Wellness Jackpot Sample Kit
  Register to win a FREE iPod nano from our drawings. Fill out your source code for automatic entry.

Please click the Submit button ONLY ONCE.
This may take a few seconds to process.

Wellness Jackpot® is a registered trademark of The Peavey Corporation.  U.S. Patent Pending.
 
| Home | Program Overview | Jackpot Clients | Program Promotion | Contact Us |