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WHOLESALE ORDER AND INQUIRY FORM            
 

Thanks for the inquiry! To place an order, please fill out the fields below.

For questions or to become a new retailer or distributor, please submit your contact information (any additional comments can be placed in bottom field).

 
Company Name Primary Contact Name
   
(no need to fill out address/contact info if you already have an account with us)
   
Shipping Street Address 1 City
Shipping Street Address 2 State Zip Code
Country
Email * (Required) Phone Number  
 
   
Order Request (i.e. 12 bottles FertilAid for Men, 2 cases Pregnancy Plus, etc.)
 
If not a current customer, please describe your business (online or physical retail, healthfood store, specialty shop, physician's office or clinic, etc.)
 
Payment Information
Please charge credit card on file

If no card on file, please call (360) 543-7888 to set up your account or provide
payment detail.
 
Please email me your latest wholesale pricing information

     
Comments or Questions?
 
 


Call 1-800-367-2837 or Contact Us
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Fairhaven Health LLC, Impregnating, Bellingham, WA
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* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.