HydraWav3 Pre-Sale

This information is required for pre-sale of the devices.

Please Contact Us At shiva@elem5.com If You Have Any Problems

If you prefer a different payment method, please contact Shiva at (480) 335-3405

1. First Name 2. Last Name 3. Business Name (Optional) 4. E-mail address 5. Phone Number 6. Mailing Address 7. City 8. Country 9. State: (Select Or Type) 10. Zip Code

I agree to the

12. Choose Your Payment Option:

Sale: HyrdraWav3 Device: One Time Payment of $649 For Pre-Sale

Sale: HyrdraWav3 "Plus" Device : One Time Payment of $649 For Pre-Sale

Partial Payment: $300 Deposit (Remaining $349 due a week before shipment)

Coupon: I have coupon code for $599

I would like to donate

13. What is your payment method?

Credit Card (Visa, Mastercard, American Express, Discover, JCB)

PayPal

HydraWav3 Pre-Sale

Presale Purchase Agreement