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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:*
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





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

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