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Thera Health Customer Code
*
Business Name
*
Business Type
Fitness Centre/Personal Trainer
Flannery stores
Go Vita
Great Earth
Healthy Life
Health Foods
Herbalist
Homeopath
Independent Health Shop
Independent Pharmacy
Massage/Accupuncturist
Naturopath
National Pharmacies
Nurse/Midwife
Nutritionist
Dietician
Occupational Therapy
Optometrist
Ostoepath
Pharmacy
Physiotherapist
Phsychologist/Psychiatrist
Stay Healthy
OTHER
Please enter your Business Type
Billing Address
Is this also your delivery address?
Yes - All deliveries to this address
No - I want to add a delivery address
Delivery Address Details
Make this my default address for ALL parcel deliveries
Please just keep this address on file - I will let you know if I need items sent here
Business Phone Number
Business Email
Key Contact Person
Key Contact Person Phone
Key Contact Person Email
Accounts Department Email (for statements)
Leave blank if this is the Main Email
Other Notes?
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