Reseller Application Form

To be considered as a Vitality 4 Life Approved Reseller, please tell us about your company and the current marketplace you service.

Personal Information Contact Person: *
Company Name: *
Website:
Email: *
Telephone: *
Mobile:
Fax:
Address: *

City: *
Country: *
Postcode:

About Your Business Description of your company:
Number of employees :
Sales team size :
Types of products you currently market :
Describe your experience in marketing health related products:
How would you market Vitality 4 Life Approved products:
Choose the type of reseller account:
Can you meet a minimum first order of A$2000:
Supporting Accreditations:

Service and Delivery Regions Which country:
Area with your country:
Ship To:
Languages Supported:

Promotion

Which Products are of Interest?

Air Purifiers

  Air Purifier Zalmandn NBA100
  Air Purifier Zalmandn NBA150
  Air Purifier Zalmandn NBA350
  Air Purifier Zalmandn NBA700

Detox Program

  Dome Portable Infrared Sauna
  Iyengar Detoxifying Yoga Retreat
  Iyengar Yoga Retreat with Simon Marrocco
  Sauna 3 Person Far Infrared Sauna
  Yoga and Healing Retreat in Ubud - Bali

Fitness Equipment

  Vibration Machine Vibro Disc
  Vibration Machine Vitality1200
  Vibration Machine Vitality300
  Vibration Machine Vitality600
  Vibration Machine Vitality700
  Vibration Machine Vitality750
  Yoga Swing

Gardening

Home Composter
Little Pig Home Composter

Health Books

Norman Walker Book Set

Health Supplements

  Absolute Red Dried Berries - Goji Berries
  Absolute Red SuperPower Facial Oil - Goji Berries
  Absolute Red Wolfberry Powder - Goji Berries
  Trace Minerals Drops - Concentrate Trace Minerals

Juicers

  Galaxy Juicer / Food Processor with New Oscar Front End
  Juicer - Oscar 902 Pro
  Juicer Champion 2000+
  Juicer Chrome Oscar VitalMax Juicer
  Juicer Green Power Hippocrates Twin Gear Juicer
  Juicer Samson Juicer
  Juicer White Oscar VitalMax Juicer
  Manual Wheatgrass Juicer
  Manual Wheatgrass Juicer - BL30
  Manual Wheatgrass Juicer - MK3
  Oscar Living Juicer - The Baby Oscar

Kitchen Appliances

  Absolute Red Wolfberry Puree - Goji Berries
  EasyGreen Sprouter - Wheatgrass - Sprouts
  Excalibar Food Dehydrator
  Ezidry Food Dehyrator - Classic
  Ezidry Food Dehyrator - Snackmaker
  Ezidry Food Dehyrator - Ultra
  Grain Master Whisper Mill
  Power Mill Blender - Super Powered Food Processor
  Soyquick Soy Milk Maker & Tofu Press
  Wheatgrass Kit - Organic Wheatgrass Starter Kit
  Wheatgrass Starter Kit plus Juicer

Massage Chairs

Massage Chair

Oral Care

  Hydrofloss Oral Irrigator
  Perioclear Mouthwash
  Periocomfort Soothing Gel
  Periopaste Toothpaste
  Perioscript Solution for Hydrofloss
  Sonic Toothbrush
  Tooth Floss & Brush

Water Filters

  Aquasana Shower Water Filter
  Aquasana Water Filter
  Aquasana Water Filter + Shower Filter Combination
  Aquasana Whole House Water Filter
  Neos Vital Energy Water Purifier
  Water Distiller Odev WD717
  Water Ionizer BionTech BTM105U
  Water Ionizer BionTech BTM200N
  Water Ionizer BionTech BTM3000
  Water Ionizer BionTech BTM800
  Water Wise 4000 Water Distiller
  Water Wise 9000 Water Distiller

I understand that this is not a contract nor does it constitute an agreement toward partnership and/or representation. It is for informational purposes only. I certify the accuracy of the above information.

Name of person submitting this form:
*

Type in the validation code from the image. (case sensitive)

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