Apply for a Wholesale Account

Use this form to apply for a wholesale account.

Customer Information

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Shipping Address

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City

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Please provide two credit references for your business. References cannot include utility providers or banks. Required

Practitioners: Please provide a copy of your qualifications.

Students: Please provide evidence of your enrolment and the year of study you are currently undertaking i.e. letter from institution.

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Tick to receive marketing communications from Phytomed.

I understand and agree that all orders made and all goods supplied by Phytomed Medicinal Herbs (Phytomed), are made and supplied subject to the attached terms & conditions of sale and understand all prices are exclusive of GST and are subject to change at Phytomed's discretion. All information provided is true. I authorise a representative of Phytomed to discuss my credit history with the contacts provided, or any other person which Phytomed may consider necessary in the course of its business, including credit assessment, debt collecting and direct marketing activities.

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