Professional Customer Registration

Thank you for your interest in Ayush Herbs®, Inc.. In order for us to process your order efficiently, please fill out the information in the form below, entering your tax id number and uploading your current business license. (Note: Your account will not be operational until all appropriate documents/ professional information are submitted and approved by the Ayush Herbs® online operations department. If you are an existing Ayush Herbs® customer, you do not need to upload your license or MAP policy again, just fill out your name, email, business name and tax id. However, you still need to wait for final approval before purchasing.) 

*Required: Download the Ayush Herbs® MAP Policy. (Please sign and date the MAP document and upload below. Please note that we require to have a signed MAP on file before shipping out all orders) *

If you have any questions or need assistance with this form, please call our office at 425-637-1400 between the hours of 8:00 a.m. and 4:00 p.m. PDT Monday through Friday.

 
First Name *
Last Name *
E-mail Address *
Name of Business or Practice *
Phone Number *
Mailing Address *
City *
Select a State *
Zipcode *
How did you learn about Ayush Herbs? *
Tax ID # *
Conference Code *
If you were given a unique code by one of our sales reps, please enter that here
Please Download Our MAP Policy

*Required: Download the Ayush Herbs® MAP Policy. (Please sign and date the MAP document and upload below. Please note that we require to have a signed MAP on file before shipping out all orders) *

MAP Signed Policy (Up to 5mb - .pdf, .docx, .xlsx, .jpg, .png, .gif) *
Professional License (Up to 5mb - .pdf, .docx, .xlsx, .jpg, .png, .gif) *
Don't You Want To Be Added To Our Practitioner Locator Map? *
Our practitioner locator map allows potential patients who live in your area to easily locate your business.