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This Center Information Form is for PUBLIC EESYSTEM CENTERS currently listed (or want to be listed) on the EESystem website map. This form also updates our internal records.

Please note, EEQube's will not be added to the map.

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What system do you have? ^*

Please note, EEQube's will not be added to the map.

EESystem

EEQube

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What is your EESystem Owners Portal Login Email? ^*

Inputting your Portal login email will update your internal records for us automatically. In most cases, this should be your Wholesale login email by default.

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How many centers do you own? ^*

Include both open & coming soon centers you own.

2 or More

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We ask that you submit one of these forms for EACH of your centers.

This ensures information is properly updated in our system as well as on the website map listing.

Our system will not auto-update your information and one of our team members will manually update your internal records to ensure accuracy for each center/system owned.

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📂 INTERNAL RECORDS

The following questions are for our internal records only. This information will not be public.

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Center owner/partner first & last name(s) ^*

Separate each name with " / " as outlined below.

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Primary Contact Email ^*

This will be the primary email on file that we use to contact you for internal reasons.

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Contact Phone Number ^*

This will update one of the phone numbers on file that we use to contact you for internal reasons.

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🏥 CENTER INFORMATION

The following questions may be used publicly, such as on the map listing for your center.

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Center Name ^*

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Center Status ^*

Open

Coming Soon

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Center Country ^*

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Do you have a confirmed address for your center? ^*

Yes

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⚠️ CONFIRMED ADDRESS DISCLAIMER

Please ensure your address matches the location on your EESystem agreement. This ensures proper spacing amongst other centers and is required for our records.

We will review your address upon submission and advise if there are any issues or deviations from what you had originally signed for.

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What is your center location? ^*

If you do not have a confirmed address, please provide your city/town as a general location for the map.

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Center Email ^*

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Center Phone Number ^*

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Center Website

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Your Center Information Form Has Been Submitted!

We will review and update your center listing as soon as we can (normally within 2-4 business days).

Have 2 or more centers? Submit another Center Info Form below.

Submit Another

At this time, we do not classify EEQube's as "Centers" and will not be added to our website map.

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