Professional Customer Registration

Thank you for your interest in Ayush Herbs®, Inc. In order for us to process any of your future orders, you must fill out the information in the form below, enter your Tax ID number and upload your current business license, and submit the form for our review. 

(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 again, just fill out your name, email, business name and Tax ID. However, you still need to wait for final approval before purchasing.) 

*Required:

  1. Download the Ayush Herbs, Inc. Authorized Retailer Policy. All applicants must review the complete terms of the Authorized Retailer Policy and agree to adhere to the same before submitting their application.
  2. Download the Ayush Herbs, Inc. Map Policy.

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
Professional License (Up to 5mb - .pdf, .docx, .xlsx, .jpg, .png, .gif) *
Let Us Know If You'd Like To Add Your Practice To Our Practitioner Map On The Ayush Herbs Website. (Optional) *
By submitting this Registration Form, you:
(i) Certify that the information stated above is true and accurate; (ii) Acknowledge that authorization to sell Ayush Herbs products is only granted after Ayush Herbs, Inc. has approved of you to be an Authorized Retailer; (iii) Agree to adhere to the terms in the currently effective Ayush Herbs, Inc. Authorized Retailer Policy, if approved by Ayush Herbs, Inc. to be an Authorized Retailer;
*