To qualify for our Preferred Professional Membership status and received discount pricing, you must be a licensed Medical Professional, Practitioner, Health Food Store Owner, or other licensed business that services the nutritional industry. A business license number or resale license number is required to for approval. |
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| I was referred to Life Science Product by: |
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| *Business Name: |
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| *First Name: |
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| *Last Name: |
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| *Address: |
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| City: |
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| State: |
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| Zip: |
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| *Country: |
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| Office Phone: |
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| Fax: |
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| Email: |
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| Do you have an office, clinic or store? |
| Yes |
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No |
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| *Business License Number: |
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| *Resale Tax License Number: |
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| Do you meet with at least 30 clients a week? |
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Yes |
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No |
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| How many years have you been in business? |
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| What is your professional title? |
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Thank you for completing our application. We are pleased to assist you in enhancing patient care while increasing revenues through the sale of quality products in your practice. Your application will be reviewed promptly. Upon acceptance, we will notify you via email with pricing and your online login information. This process may take 5 to 7 business days. If you need to place an order before that time, please call our office directly during normal business hours at: Phone: 713-466-9001 Fax: 713-477-9018 |
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