Complete the interest form below and our representative will be in touch within 24 - 48 hours.

Title

First Name

Last Name

Phone *

Email *

Organization Name

Address *

Street Address

City

State

Country

Postal code

Type of Health Professional?

Do you have a physical location where you see clients?

Yes

Other

Do you sell online?

Yes

Website URL (optional)

Are you a registered business or health professional?

Yes

What is your legal structure? (E.g. Individual, Sole Proprietor, LLC, Partnership, Corporation, Non Profit etc.) (optional)

Professional License or Business Registration Number & State (If Available) (optional)

Products You Are Interested in Sharing with Your Audience? (optional)

Super herbs interested in? (optional)

Our Minimum Advertised Price (“MAP”) policy ensures consistent, value based pricing. I will not sell products online or below MSRP without express permission. Read entire policy here: https://www.herbalgoodnessco.com/pages/minimum-advertised-pricing

Yes, I agree to the MAP Policy.

How did you learn about us? (optional)

Never share sensitive information (credit card numbers, social security numbers, passwords) through this form.