WishGarden Herbs :: New Account Sign-Up


View a printable version of this form here
* Indicates a required field
For multi-store chains, please provide a corporate address and contact info here, and upload a document in xls, doc, pdf, or plain text format containing a list of your stores with their shipping address, phone number, email address (if applicable), and store contacts.

Business Name*

Primary Email*

Primary Phone*

Company Website*
Facebook page is accepted if you do not have a company website


Shipping Address
 
Care of Address* City* State* Zipcode*


Contacts


General Contacts
Name
Job Title
Phone
Email
Name
Job Title
Phone
Email
Name
Job Title
Phone
Email


Billing Contact*
Name
Job Title
Phone
Email
Name
Job Title
Phone
Email


Billing Info

Terms*
If applying for Net 30 terms, please download our credit application here and attach it below.

If applying for prepaid terms, please provide credit card information at the time of your opening order.

Billing Address
 
Care of Address City State Zipcode


Retailer Info

Channel*
Account Type*
Membership


Policies
For your reference, please download the appropriate vendor policies for your type of business:


Uploads

If applicable, upload a list of stores here.

Upload your retailer policies for our records, or any other applicable documents pertaining to your application.

Upload your business license and/or pracitioner license/certification here. *
If you have a state sales tax ID, please upload it here.