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
Education
ACCOUNTS
Contact
Order/Prescribe Online
- B2B/Wholesale Orders
- Patient Scripts - Practitioner Login

New Account
Retailers

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 *

DELIVERY AVAILABLE WITHIN NEW ZEALAND ONLY

Billing Street Address *

Billing address 2 *

Billing City *

Billing Region/State *

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

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

​Account Type:

Trade References:

Guarantor Details

Additional Accounting Details:

Subscription to our Newsletter & Specials

Your Responsibilities

Terms & Conditions:

Personal Guarantee:

New Account
Retailers

Natural Product Retailer | Account Application Form

Account Type: