Online Store

Profectiv Preferred Program Registration

All personal information provided to us will be strictly kept confidential.
Fields marked with * are required.

Thank you for your interest in Profectiv Products.  
Desired Username: *  
Desired Password: *  
First Name: *  
Last Name: *  
Address 1: *  
Address 2: Optional  
City: *  
Country: * Required  
State:
* USA, Canada, Most EU, Other
 
Postal Code / Zip: * Required for almost all  
Telephone: Optional  
Email: * Used to send your username and password  

 

Please tell us about your hair so we can customize the sample combinations that will work best for you. Do you suffer from any of these common hair and scalp problems?

 

 
 Please check all that apply: Breakage
Hair Dryness
Scalp Dryness
Chemical Damage
Split Ends
Scalp Itching
Thinning Edges
Flaking
Heat Trauma
Dandruff

 
 Current Hair Style: Braids
Cornrows
Twists/Locs
Straight/Relaxed
Wavy/Texturized
Natural
Other, please specify:
    
 

 
 Do you use a hair relaxer?  
No Answer At Home Salon Both Home/Salon Do Not Relax

 
 Do you use hair color?  
No Answer At Home Salon Both Home/Salon Do Not Color

 
 Do you wear?  
No Answer Bonded (Glue-In) Weave Sew-In Weave Do Not Use Extensions  

 
 Optional: Please share information that will help us better know Profectiv consumers.  

 
 How did you learn about Profectiv?  
 Please check all that apply: Magazine Ad
Word of Mouth/Friend/Relative
Web Search
Community Event/Expo
At Store Shopping
Other, please specify:
    
 

 
Age Range:   

 


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