Contact:

T: 425.405.5783
E: VitaeWellnessSolutions@gmail.com

Mailing: PO BOX 1085 Carnation, WA 98014-8799

Schedule a call or virtual appointment through MyTime:

Schedule

Register for a Professional Account

Name

First Name

Last Name

National Provider Identifier (NPI)

Degree Type

License Number (if applicable):

Date

YYYY

Wholesale Account Application for:

Gaia Pro Herbs

Doctors' Research

Body Health

Orso Pro CBD

Phone

Country

(###)

###

####

Business Name

Tax ID/EIN

Website

http://

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is billing address different?

Yes

No, it is the same

Billing Address (if different)

Referred By:

Initial Questions for Rep Follow Up:

Signature of Resale Policy

By signing below, you acknowledge this application is reflective of your licensing and/or credentials. You also understand that promoting or reselling products on Amazon, eBay, Google Ads, or any other reseller website is strictly prohibited. Allowances are granted to practitioners selling products on their own website at suggested retail prices (SRP), however, selling or advertising products online for less than SRP may result in permanent suspension of wholesale privileges. Selling in a retail environment is prohibited without prior approval. Lastly, you are not allowed to make medical claims regarding these supplements. State law prohibits nutritional supplements from claiming “diagnosis, prevention, or cure of any disease, pain, deformity, injury, or physical or mental condition.” Your sales professional or Doctors’ Research staff can assist you with questions about your new account. Thank you for the opportunity to serve you and your patients/clients.