Natural Partners USA
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1. Business Nature: Acupuncturist Bike Store Chiropractor Clinics Dentist Dietitian Gym Health Food Store Herbalist Homeopathy Hospital Medical Doctor Midwife Naturopath Nutritionist Osteopath Personal Trainer Pharmacy Physiotherapist Registered Nurse Sporting Goods Staff Traditional Chinese Medicine
2. Natural Partners No.: Note: Natural Partners customer number (optional)
3. * Practice Name:
4. * Phone:
5. * Email:
6. Fax:
7. Cellphone:

1. * Username:
2.  
3. * Password:
4. * Confirm Password:
5.  
6. * Salutation: Mr. Mrs. Ms. Dr. Dr. (Phd)
7. * Job Role Choose One Acupuncturist Biochemist Chiropractor Dentist Dietitian Doctor Health Food Retailer Herbalist Homeopathy Lecturer Masseur Myotherapist Naturopath Nurse Nutritionist Osteopath Other Owner Personal Trainer Pharmacist Pharmacy Assistant Physiotherapist Practice Manager Practitioner Purchaser Receptionist Student Traditional Chinese Veterinarians
8. * First Name:
9. * Last Name:
10. * Phone:
11. * Email:
12. Fax:
13. * Cellphone:

Practitioner Information

1. * Designation: Authorized Patient Online Purchasing BA Certified Classic Homeopath Certified Clinical Nutritionist Certified Herbalist Certified Nurse Midwife Certified Occupational Therapist Clinical Ayurveda Specialist Doctor of Chiropractic Doctor of Dental Surgery Doctor of Homeopathic Medicine Doctor Of Medical Dentistry Doctor of Optometry Doctor of Oriental Medicine Doctor of Osteopathy Doctor of Podiatric Medicine Doctor of Veterinary Medicine Health Food Store Health Related Degree Health Related Degree Graduate HWA Independent Pharmacy Licensed Accupuncturist Licensed Massage Therapist Licensed Professional Counselor Medical Doctor MS Naturopathic Doctor NP Guest NP Script Nurse Practitioner PHARMACEUTICAL CHEMIST Pharmacist PHD Physical Therapist Physicians Assistant Purecapsdirect Registered Dental Hygenist Registered Dietician Registered Nurse Student To Be Determined VND Wellthsmart Employee WW
2. License/Certificate: (PDF, PNG or JPG only)
3. Please upload to our site or email a copy of your license/certificate. Have your license/certificate proudly mounted on the wall? No problem, take a picture with your phone and upload to our site or email to bioceuticals@naturalpartners.com with the Subject: New Account Application/License Attached.

I/We have read and agree to the Terms & Conditions of sale, the Fit-BioCeuticals Privacy Policy, and the Natural Partners Terms & Conditions, and: I/We hereby authorise FIT-BioCeuticals Ltd. to make any enquiries or disclose any information concerning my/our credit worthiness to any person or source as considered appropriate by FIT-BioCeuticals Ltd. If granted credit, I/We agree to comply with and be bound by the Terms & Conditions (as amended from time to time). My/Our financial situation is satisfactory and I/We can meet all financial obligations. There are no lawsuits against me/us at this present time. I/We make an application for an account for the purpose of obtaining merchandise from FIT-BioCeuticals Ltd.