Become an AOR Retailer

Personal Information

Doctor/Practitioner Name:*

Type & License #:

Company/Clinic Name:*

Business Licence:*

Phone:*

Fax:*

Email:*

Website:*

Contact Name:

Receive Monthly Specials through:

Fax

Shipping Information

Shipping Address*

Street Address City State ZIP Code

Is Mailing Address different than Shipping Address?

Yes
No

Mailing Address (if different)

Street Address City State ZIP Code

Attached Information

How did you hear about us? Please explain*

Attach Files (Type & License #, Business License)

Drop files here or

AOR products are available to the following: Medical Doctors, Naturopathic Doctors, Medical Clinics, Pharmacies, Dispensaries and Health Food Stores. A copy of a diploma for professionals or business license for retailers is required to set up an account. A list of schools accepted by AOR for Naturopathic designation can be found at http://www.nabne.org/approvedprograms.php

AOR products are not available to the following: home based businesses, mail order companies or direct to consumer.