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Gaia Herbs Organic Farm, Brevard, NC

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Practitioners, register for exclusive access

If you need assistance, please contact [email protected].

* = Required fields

First Name *

Last Name *

Email Address *

Phone Number *

Practice Name *

Practitioner Speciality *

Upload Practitioner Credentials *

Note: To activate your account, please upload your credentials.

Upload Tax Resale Certificate

Note: Tax will be applicable on your purchases if tax certificate is not uploaded

Tax ID/EIN

Note: This information is required for wholesale accounts

Address Line 1 *

Address Line 2

Country *

State/Province *

City *

Postal Code *

Use same address as Business

Note: We cannot deliver to PO box

How did you learn about us? *

Do you currently sell Gaia Herbs products? *

Yes

No

Do you have a website? *

Yes

No

How do you get herbs and supplements to patients? *

This account is for personal/educational use only

Sell in office

Refer to a retail shop

Refer to an online shop

Use a patient drop ship or online patient dispensary program

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