new_account | Alterra/Herbasanté Pro

Type *

Select the type of application

Application for retail partners (e.g. health product store, grocery, etc.)

Applications from professional partners (practitioners, such as ND, MD, chiropractor, nutritionist, etc.)

I want *

to create a new account

to update an existing account

Do you have an image (or PDF) of your active business license to upload and a GST number to complete the online application?*

Yes

No

Do you offer comparable brands in the natural supplements industry?* *

Yes

No

Date

Business Name *

GST/HST Number

Business license number

Type of business

Sole Proprietor

Business

Franchise

Other

Are you an online retailer?

Yes

No

Do you sell on Amazon?

Yes

No

Phone

Email *

Receive updates from Herbasanté by email *

Yes

No

Is it the same as the buyer/manager's contact information?

Yes

No

Street *

Address Line 2

City *

State / Province *

Zip *

Do you have a different billing address? *

Yes

No

Street (billing address)*

Street 2 *

City *

State / Province *

Zip Code / Postal *

First & Last Name *

I accept all the terms and conditions listed above *

Authorization

By signing the terms and conditions of the retail partner, you hereby agree to allow Herbasanté to list your business as a retailer or clinic on the Herbasanté website or on its promotional materials. If you do not consent, please contact the Excel
The person signing this agreement represents and warrants that they are authorized and empowered to sign this agreement on behalf of the retail partner or as their agent. If a lawsuit is filed to enforce a provision of this agreement between the parties, the prevailing party shall be entitled to reimbursement of its attorney's fees, costs, and reasonable expenses incurred in connection with such action.
AOR reserves the right to modify its terms and conditions with 60 days' notice.

Signature

Create a new account or update

This registration form is reserved for healthcare professionals or students.

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