Wholesale Application Form

BC Organic Herbs Ltd.

6471 Vernon Avenue
Peachland, British Columbia
Canada  V0H 1X8

Tel / Fax: +1 250 767 6650
Toll Free: +1 888 967 6650


Click Here For a Printable Application Form


Your Application will be sent to us by email:

* Required Info:  
* Personal Name of Applicant: 
 
  Birthdate:  
* Month:   Day:   Year:
* Place of Birth: * SS#:
 
* Business Name: * Tax ID:
 
  Mailing Address:  
* Street or PO Box:  
   
* City: * Province/State:
 
* Country: * Postal/Zip:
 
* Business Phone: Home or Cell Phone:
 
* Email:   Fax:
 
* Business Class: * Business Type:
  Individual
Proprietorship
Partnership
Company 		 Retail
Wholesale
Distributor
Company
Direct Sales
Ecommerce
  Other major vitamin/health food products currently being carried? 
 
  Geographical area covered by your current marketing? 
 
  How did you first learn about Super Naturals Heart Formula?   
 
  Please provide 2 references
(name/address/personal contact/phone number) 
 
  What are the main reasons in your decision to market
Super Naturals Heart Formula?
 
     
    

Please be confident that we will never give or sell any of your information provided by this form.
It will be used only to contact you if requested. Your security and privacy is protected.


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