Phone: 0800 553-556

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New Account
Retailers

Natural Product Retailer | Account Application Form

Your New Retailer Account

* 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

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 *

DELIVERY AVAILABLE WITHIN NEW ZEALAND ONLY

Billing Street Address *

Billing address 2 *

Billing City *

Billing Region/State *

COUNTRY *

Enter your Country

Accounts/Billing Details

How I Want to Pay: *

On Account (Monthly Statement) Pre-paid

Trade References:

For On-Account/Credit Applications Only
(If pre-paid, just put NA in these fields).

TRADE REFERENCE 1 *

For On-Account/Credit Applications Only. If pre-paid/pay-as-you-go, just leave this blank

TRADE REFERENCE 2 *

For On-Account/Credit Applications Only. If pre-paid/pay-as-you-go, just leave this blank

TRADE REFERENCE 3 *

For On-Account/Credit Applications Only. If pre-paid/pay-as-you-go, just leave this blank

PHONE 1 *

PHONE 2 *

PHONE 3 *

Additional Accounting Details:

(Statements will be sent to this email address if different from the default email address on the account)

Accounts First Name *

Accounts Last Name *

Accounts Phone *

ACCOUNTS EMAIL *

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

Name of Guarantor *

DATE *

Submit Your Application

Established in 1993, ProHerb is proudly owned and operated in New Zealand.

ProHerb Ltd Office Hours: 8.00am - 4:30pm, Monday - Friday
Phone: 64 3 381-2255 | Fax: 64 3 381-2256 | Phone Toll Free: 0800 553-556 | enquiries@proherb.co.nz

Terms and Conditions

Policies & Returns

New AccountRetailers

Natural Product Retailer | ​Account Application Form

Your New Retailer Account

Address Details

Delivery

Billing

Accounts/Billing Details

Trade References:

Additional Accounting Details:

Subscription to our Newsletter & Specials

Your Responsibilities

Terms & Conditions:

Personal Guarantee:

New Account
Retailers

Natural Product Retailer | Account Application Form