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Practitioner   
Practitioner Search ~ To be a Wholesaler
 

We supply Life Rising Formulas to all qualified health professionals, pharmacies and health food stores.

Wholesale Account Application (All * fields are required)

Date:* (MM/DD/YY)
 
Business Name:*
Business Address:*  
City:* State:* Zip:*
Business Phone:* Fax:*
 
 
Name of the main doctor or practitioner:
Name of contact person:*
Position:
Business Scope:*  
Tax ID#:* Resale Tax ID#:
 
 
Average Annual Sales:*
    0-10,000          10,000-50,000       50,000-100,000
    100,000-500,000  500,000-1,000,000  Over 1,000,000
 
 
Please list two business with their telephone number for reference:
1)    Tel:    Years
2)    Tel:    Years
 
 
How do you know us?*

a.** Referred by our current practitioner or patient:

b. From Magazine ad (please specify magazine):

c. From Show (please specify show)

d. Direct mailing
e. From Web Site
f. From TCM School lecture
g. Contacted by sales person (please specify name of the sale person)
h. Others
 
 
    

*Please send us a copy of your Business License and Certification*
Fax: 312-842-1553
Mail: Tonshen Health, 2131 S. Archer Ave. Suite B, Chicago IL 60616

 

   

 

 

  line
office ~
7884 S. Quincy St Willowbrook, IL 60527
~ Phone: 630-654-0617

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