Phone:
0800 553-556
About
About Us
Meet Our Team
Practitioner Only
Patient Prescribing
MediHerb
Eagle
Orthoplex
Bio-Practica
Heel
Brauer
Medicine Tree
Dr Reckeweg
Natural Products
Bellamy's
Bonsoy
Carwari
Good Morning Cereals
Mia Belle
ProHerb Oils
Spiral Foods
Wotnot
Retail Stockists
Education
Bioconcepts Engage
BioPractica Learning Hub
Integria Education
Books
ACCOUNTS
Apply Now, Or Upgrade
Health-Practitioner & Clinic Account Application
Retailer Account Application
Student Account Application
Contact
Order/Prescribe Online
B2B/Wholesale Orders
Patient Scripts - Practitioner Login
Apply for an Account
Natural Product Retailer | Account Application Form
Your New Retailer Account
*Required Fields.
*
Indicates required field
Your New Account Name (Company name):
*
Display Name for your Account. Either your business name, or your name if trading as a sole trader.
My Business is trading as a:
*
Registered Company
Sole Trader
Indicate your type of business here
I would like to order online for my store
*
Yes
No - Phone & Email Only Please
Your First Name
*
Your Last Name
*
Your Phone
*
Your Email
*
Your Website
*
Address Details
Delivery
Billing
Delivery Address (default)
*
Street address only - use this tool: https://www.posthaste.co.nz/address_checker.html
Delivery address 2
*
Apt/Building Name/Business Name/ extra address information
Delivery CITY
*
DELIVERY REGION/STATE
*
Auckland/Northland
Bay of Plenty
Canterbury
Central North Island Districts
Hawkes Bay
Kapiti Coast Districts
Nelson/Marlborough/West Coast
Otago/Southland
Taranaki
Waitkato
Wellington
DELIVERY AVAILABLE WITHIN NEW ZEALAND
ONLY
Billing Street Address
*
Billing address 2
*
Billing City
*
Billing Region/State
*
Auckland/Northland
Bay of Plenty
Canterbury
Central North Island Districts
Hawkes Bay
Kapiti Coast District
Nelson/Marlborough/West Coast
Otago/Southland
Taranaki
Waikato
Wellington
Overseas
COUNTRY
*
Enter your Country
Accounts/Billing Details
Account Type:
I am applying for a
*
Pre-Paid Account
Direct Debit Account
Click Here to download the Direct-Debit Authorization Form.
If applying for a direct-debit account, the completed Direct Debit Authorization Form is needed to finalise your application.
Trade References:
TRADE REFERENCE 1
*
For On-Account/Credit Applications Only. If pre-paid/pay-as-you-go, just leave this blank
PHONE 1
*
TRADE REFERENCE 2
*
For On-Account/Credit Applications Only. If pre-paid/pay-as-you-go, just leave this blank
PHONE 2
*
Guarantor Details
Guarantor ID Drivers License / Passport
*
Max file size: 20MB
I confirm that these details are submitted with the authority and approval of the Guarantor.
*
Yes
Legal Name of Guarantor
*
First
Last
This is required in order to establish your account.
Guarantor's Email
*
Phone
*
Guarantor's Address (Street)
*
Guarantor's Address 2
*
Guarantor's City
*
Guarantor's State/Region
*
Additional Accounting Details:
(Statements will be sent to this email address)
Name
*
First
Last
Accounts Email
*
Accounts Phone
*
Subscription to our Newsletter & Specials
I would like to subscribe to the ProHerb e-newsletter to stay updated with products, announcements, resources and educational events:
*
YES
NO
Email For Newsletters & Educational Material
*
Your Responsibilities
Terms & Conditions:
Personal Guarantee:
I HAVE READ AND AGREED TO THE PROHERB TERMS AND CONDITIONS
*
YES
ProHerb Terms and Conditions
From time to time, ProHerb’s suppliers request client names and contact details for their databases. Do you give ProHerb permission to forward this information to its suppliers?
*
YES
NO
I WOULD LIKE TO BE LISTED AS A STOCKIST ON YOUR WEBSITE
*
YES
NO
Being listed on our site as a stockist, can help drive internet traffic and customers to your business. If you would like to be listed, please also list us as a supplier on your site.
In consideration of you supplying to my company such goods as I may from time to time order I hereby personally guarantee as a continuing guarantee the due payments of your account. I agree that no granting of time waiver, indulgence or neglect to sue by you shall impair my liability but as between you and me I shall be deemed to be the principal debtor.
I have read and understand the guarantee and confirm my acceptance of this guarantee.
*
YES
DATE
*
Having Trouble Submitting Your Application?
Please ensure that all fields and checkboxes have been completed and filled.
Once your form has been submitted you will be taken to a confimation page.
Submit Your Application
About
About Us
Meet Our Team
Practitioner Only
Patient Prescribing
MediHerb
Eagle
Orthoplex
Bio-Practica
Heel
Brauer
Medicine Tree
Dr Reckeweg
Natural Products
Bellamy's
Bonsoy
Carwari
Good Morning Cereals
Mia Belle
ProHerb Oils
Spiral Foods
Wotnot
Retail Stockists
Education
Bioconcepts Engage
BioPractica Learning Hub
Integria Education
Books
ACCOUNTS
Apply Now, Or Upgrade
Health-Practitioner & Clinic Account Application
Retailer Account Application
Student Account Application
Contact
Order/Prescribe Online
B2B/Wholesale Orders
Patient Scripts - Practitioner Login