Garden of Life | Partners | Retailers




Thank you for choosing to open an account with Garden of Life. To establish and account with us, we ask that you: 1. Have an existing health-related business. 2. Possess one of the following. a. Professional Certification b. License c. Resale License d. Business License 3. Submit this application and fax relevant licenses or certificates to 866.465.0034.

Contact Information

Business Name*

Phone*

Email*

Fax

Mailing Address

City

State

Zip

Shipping Address (if different)

City

State

Zip

Business Information

Type of Business or Practioner
PractionerOther

Type of Business

Practitioner License Number

Business Website

Reffered By: (How di you hear about us?)
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Method of Payment
All orders processed by Garden of Life will be billed via credit card or C.O.D.

IMPORTANT NOTE: Please do not submit your credit card information via this online form.
After submitting this form, you will be contacted by one of our customer service representatives to take your initial order and credit card information.

Accounts Payable Contact

Authorized Signature

By submitting this form, I Recognize And Accept The Conditions Shown Above And Certify That All Information Listed Is Correct And Accurate.

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