Account Application

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Please indicate if this is a Store or a Professional Account Application *

Business Name *

Legal Name if Different

In Business Since

Where do you intend to sell our products *

Contact Name / Name of Professional (copy)

Professional Designation (Professionals Only)

ND, CHP, DC, RHN

Professional License Number

Professional License Number Please Upload Proof of Your Credentials (for professional applicants only)

Drag & Drop Files, Choose Files to Upload

Billing

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone

Fax

Email *

Shipping Address (If different from billing address)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone

Contact Person

Accounts Payable Information

Visual Code

A/P Contact Name

Phone

Fax

do Information Number

Email *

From time to time St Francis Herb Farm emails flyers, webinars, specials, product changes & other information. To subscribe to receive SFHF email updates please check the box below.

• Yes

Additional Comments

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All orders are to be paid by credit card at time of order. A valid credit card must be supplied to be held on file or when an order is placed. To request Net 30 day Credit Payment terms please complete a SFHF Customer Credit Application Form available through customer service.