First Name *

Last Name *

Email *

Terms & Conditions 1) I agree to the HealthForce MAP Policy and will not advertise in any form (web, print, in store promotions or other forms of media) below the set MAP prices as listed on the HealthForce Price list. MAP is the same as Everyday Low Price (EDLP) which is also the price listed on the HealthForce web store. 2) I agree to the minimum order amount of $200 to get my On Going Discount ("OGD"). If my order is below this amount I will pay the higher Regular Wholesale Cost. 3) I will pass on the OGD to my customers with Every Day Low Pricing ("EDLP") Tags 4) I understand that for free shipping my minimum order needs to be $250. If I order less than this amount I will pay 100% of the shipping. 5) I agree that I will be reselling these products. 6) I confirm that this account is a genuine business and is not for personal use. 7) I understand that I cannot sell to other countries that already have listed distributors.

I accept the Terms and Conditions *

Business Name *

Phone Number (Include country code) *

Fax Number

Website Address

Billing Street Address *

Billing City *

Billing State/Province

Billing Country *

Billing Zip/Postal Code *

Shipping Street Address *

Shipping City *

Shipping State

Shipping Country *

Shipping Zip/Postal Code *

What area would you like to distribute HealthForce products? *

Do you have access to a warehouse? Yes No *

I understand that distribution is selling direct to stores and practictioners and I can sell direct to public at retail price. *

Are you familiar with the customs regulations for your region? Yes No *

I understand and am aligned with HealthForce as a Vegan, Cruelty Free, Drug Free Company? Yes No *

Why would you like to distribute HealthForce products? *

Tell us a little about your current business activities. *

What are your immediate business plans?: *

Please tell us some details about your business experience. *

Please share with us about your diet and lifestyle. *

What other products, if any, do you distribute?

Please upload a current photograph. *

What is your main sales channel? Webstore Health Practictioner Store *

Do you allow back orders? Yes No *

How did you discover HealthForce? *

What is the size of your customer base?