Professional Account Application

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In order to process any requests for product samples, this form must be completed.

To apply for a professional account, please fill out the form below. To ensure your application gets processed without delays, make sure to attach all of the required documentation. Once we receive your application, we will contact you within 5 business days.

To set up a professional account to use our products in your practice, we require a copy of your business license and professional or trade license. Professional accounts include but are not limited to: naturopaths, acupuncturists, chiropractors, massage therapists, and estheticians.

For businesses located outside of the United States and for all other inquiries, please contact us here.

Uncle Harry's Natural Products (UHNP) reserves the right to cancel or revoke professional accounts.

 

 
Primary Contact Name *
Primary Contact E-mail *
Primary Contact Telephone Number *
_____
Business Name *
Billing Address *
Billing City *
Billing State *
Billing Zip Code *
Billing Country *
_____
Shipping Address (if different from billing address)
Shipping Address *
Shipping City *
Shipping State *
Shipping Zip Code *
Shipping Country *
_____
Business License Number *
Professional or Trade License Number *
_____
Please upload any required documentation, including your business license and professional/trade license. *
_____
Tell us about your business! *
_____
By checking the below box, I certify that I will NOT be selling UHNP on Amazon.com, ebay.com, etsy.com, or on any other online website. *
 
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