Practitioner Sign-up

CONTACT DETAILS

Title

First name

Surname

Country

House Number/Name

Address 1

Address 2

Town/City

County/Region

Postcode

Preferred Phone Number

REFERRAL COMMISSION OPTIONS

Commission is paid quarterly on total value of client's purchases

30% credited to your account
25% paid by BACS transfer

WEBSITE REGISTRATION

Please register me to access www.highernature.com/practitioner for online ordering, product information and offer details

PRACTICE ADDRESS (if different)

Country

House Number/Name

Address 1

Address 2

Town/City

County/Region

Postcode

Preferred Phone Number

Type of therapist:

Other:

Practitioner/Membership association

STUDENTS

Course

College/University

Expected date of completion

PROFESSIONAL QUALIFICATION

I can confirm I am a qualified health practitioner providing personalised consultation services to clients

Please upload a copy of your Professional Qualification Certificate

MAILINGS

Please keep me informed of Higher Nature promotions and news by email.

Alternative email address if different from the contact details above

Please keep me informed of Higher Nautre promotions via the quarterly printed newsletter

From time to time we make our mailing list available to carefully screened companies whose products may be of interest to you. Please tick if you wish to receive such mailings

I would like to open a credit account

If you would like to open a credit account, please supply us with the following references (non-UK residents will not normally be offered accounts):

Bank reference

Bank:

Address:

Sort code:

Account number:

Trade or professional reference

Name:

Address:

Telephone:

After three orders, you will qualify for an initial credit limit of £100

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