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Name *

First Name Last Name
Confirm your Email *
example@example.com
Phone Number *
Mobile
Address

Street Address

Street Address Line 2

City State

Zip Code
What is your Website
if applicable
What is your Instagram username
if applicable
What is your Twitter username
if applicable
What is your Facebook
if applicable
Business Address if different

Street Address

Street Address Line 2

City State

Zip Code
App information
App Name *
name your app
What features would you like to see on your app?

View a list of features.
Choose at least 4 feat.

Appointments Coupon Calendar Video Discount SmartAds Newswall Loyalty Card Fan-wall Club Card Audio Call/GPS Radio
Choose at least 3 Colors that best represent your brand.

Red White Blue Black Yellow Grey Green Purple Pink Orange Tan Brown Teal Turquoise Hot Pink
Are you using a booking system?
If applicable please provide your booking link.
Add any additional information you would like us to know here.
I understand that

By filling out this form you agree to pay a non-refundable $250 fee to get a preview of your app. Efexxapps will build you a preview of your app based on the information you have provided in this form. This process will take approximately 3 business days. Feel free to contact us via email at admin@efexx.com

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Preview fee $ 250.00

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