WHOLESALE CUSTOMER APPLICATION

Please use this application form when applying for wholesale discounts. This form may be mailed or faxed to our office at the numbers located below and we will create your customer profile to reflect the discounted pricing. Your wholesale orders must be placed via telephone, fax, or e-mail and not through our website as it is not set up to recognize wholesale accounts. Once we receive this application, we will e-mail you with our Wholesale Price List. If you do not have a Tax ID/EIN# you may use your social security number. PLEASE NOTE: WHOLESALE CUSTOMERS ARE REQUIRED TO MAINTAIN MINIUMUM PRODUCT PURCHASES OF $200.00 PER ORDER (AT THE WHOLESALE PRICES) TO QUALIFY FOR WHOLESALE PRICES.

All products are discounted at 30% off the retail price.
Retail pricing can be found at www.viable-herbal.com.

P.O. Box 1025 • Langhorne, PA 19047 • Ph: (866) 437-3122 • Fax: (866) 437-3124
E-mail: customerservice@viable-herbal.com • Business Hours: 8:00 am to 5:00 pm (EST)
Business Name: EIN#:
Billing Information
Shipping Information
Name On Card:   Name:  
Complete
Address
(where
credit card
bill is sent):

 

 

 

 Complete
Address:		  
Phone #:   E-mail:  
Card Type:
(circle one)
Visa       Mastercard       Discover       American Express
Expiration Date:
 
Card #:
 
*3- or 4-Digit
Card Code:
 
Signature:
   * Visa, Mastercard, and Discover have a 3-digit number on the back of the card, and American Express has a 4-digit number on the front for security purposes.
Check or
Money Orders:
If using this payment method, you must submit your order first so that we can produce a shipping quote. After we respond to you with the shipping quote, please make your check or money order payable to Viable Herbal Solutions and mail it along with the completed form to the address above. Please include your order number with your check so that we can easily apply the payment. We accept U.S. funds only. Your order will be held until payment is received.

Customer Comments:

 

 
Shipping Methods
To the right are the shipping methods we offer. We do not offer COD. Your order size will determine shipping and handling costs. Saturday delivery may be added by request to any UPS shipments that apply. Please ask an associate for details.
 Standard Shipping: USPS Priority Mail (US ONLY)
 UPS Ground (US Only)
 UPS 3-Day: (US ONLY)
 UPS Second Day Air: (US ONLY)
 UPS Overnight: (US ONLY)
 International: USPS Global Express Guaranteed
 International: USPS Priority Mail International
Thank you for doing business with Viable Herbal Solutions!