Practitioner Program Application

Are you currently a licensed or certified Health Practitioner?*

The most common accepted Licensures and Certificates include: APN-C, APRN, ARNP, BCIH, CN, CNM, CPN, DC, DDS, DMD, DO DPT, EAMP, FNP, GNP-BC, CHC, HMD, LAc, LCSW, LMT, LDN, MD, MDS, MSN, ND, NP, NPC, PA-C, Pharm.D, PT, RD, RN, RPh

In order to join our Practitioner Program, you must be a licensed or certified Health Practitioner. If you don't currently meet these requirements, but feel you should still qualify for our program, please contact us at info@purethera.com.

Full Name*

First NameLast Name

Business or Practice Name*

Business Website*

Email Address*

Please provide the email address you want use to place your practitioner orders

Certification*

Please upload your Certification / License (Doc, Image, PDF, Etc...)*

Which product(s) are you interested in? *

How did you hear about us?*

Do you agree to abide by our NO Internet Sales Policy, which means you may not offer our supplements for purchase on any website, including but not limited to: Amazon, eBay, or your own website?*

Our No Internet Sales Policy means you cannot resell our products on any website. If you do not agree with this policy, you will not be able to move forward with completing practitioner program application.

PURE THERAPRO RX’S CUSTOMER PROTECTION AGREEMENT
This Agreement is between the signed health care professional (“CUSTOMER”) and PURE THERAPRO Rx.

THIS PURE THERAPRO Rx CUSTOMER PROTECTION AGREEMENT (“Agreement”) is made as of Date* (the “Effective Date”), by and between PURE THERAPRO Rx, a Colorado corporation, with its principal place of business located at 8781 Sheridan Blvd. #6080, Westminster, CO 80003; and the health care professional, First Name* Last Name* (“CUSTOMER”), with their principal place of business located at: Street Address* City* State* Zip*.

In consideration of the mutual promises and covenants herein, PURE THERAPRO Rx and CUSTOMER (“Parties”) do hereby agree as follows:

PURE THERAPRO Rx is a producer and retailer of supplements and natural health products, which are marketed worldwide under the PURE THERAPRO Rx and PURE THERAPEUTICS product line and brand name (“Products”), and the Products are exclusively distributed through PURE THERAPRO Rx managed channels.
CUSTOMER shall not disclose to any other party or entity PURE THERAPRO Rx pricing or supply PURE THERAPRO Rx products to any re-sellers or retailers.
CUSTOMER wishes to purchase from PURE THERAPRO Rx and PURE THERAPRO Rx wishes to supply to CUSTOMER, the Products for the benefit of CUSTOMER’s health care practice, patients or clients.
It is required that PURE THERAPRO Rx prohibit CUSTOMER from any and all Internet sales of PURE THERAPRO Rx Products, and CUSTOMER acknowledges, understands, agrees to PURE THERAPRO Rx’ ‘No Internet Sales Policy’ and has also informed all staff members and of this policy. Failure to follow this policy will result in immediate termination of all sales to CUSTOMER.

PURE THERAPRO Rx and CUSTOMER (“Parties”) agree as follows:
1. PURCHASE AND SUPPLY
PURE THERAPRO Rx will sell to CUSTOMER, and CUSTOMER shall, from time to time, purchase the Products from PURE THERAPRO Rx. CUSTOMER will only sell or provide PURE THERAPRO Rx products to end users, and CUSTOMER will not supply PURE THERAPRO Rx products to any re-sellers or retailers, including, but not limited to, any website including amazon.com and ebay.com.

2. CUSTOMER’S QUALIFICATIONS
At all times, CUSTOMER shall be qualified and licensed as a health care professional in the state(s) in which he/she practices and be certified or eligible in his/her specialty and subspecialty. As a health care professional, CUSTOMER agrees to administer service, care and the Products strictly in accordance with PURE THERAPRO Rx’s directions and requirements and with all applicable laws and regulatory agency requirements.

3. NO INTERNET SALES POLCY
As a material condition to this Agreement, CUSTOMER must agree to PURE THERAPRO Rx’ ‘No Internet Sales Policy.’ The terms and conditions of PURE THERAPRO Rx’ No Internet Sales Policy are hereby adopted. CUSTOMER agrees that it will not resell, sell, make any reference to prices/pricing, display PURE THERAPRO Rx images, trademarks, coupon codes or distribute any of the products using the internet, any internet device or other electronic medium or device.

Initial*

CUSTOMER may, however, refer to PURE THERAPRO Rx and the Products on its Internet Site and may include a link to PURE THERAPRO Rx’ website in the form of a standard web link (i.e. PureThera.com). CUSTOMER shall abide by this Policy and any modifications that may, from time to time, be implemented by PURE THERAPRO Rx.

4. TERMINATION AND LIQUIDATED DAMAGES
This Agreement may be terminated by either party at any time, with or without cause. CUSTOMER’s failure to comply with the terms of this Agreement and/or PURE THERAPRO Rx’s No Internet Sales Policy is a breach of contract, resulting in immediate termination of CUSTOMER’s right to purchase any Products. PURE
THERAPRO Rx reserves the right to enforce its statutory rights to recover damages against Customer for trademark infringement and the like.

5. ENFORCEABILITY, CHOICE OF LAW, VENUE, AND JURISDICTION
Failure to enforce any of the terms and conditions of this Agreement shall not be deemed a waiver of such terms or conditions, or of future rights to enforce all terms and conditions. Any dispute under this Agreement or related to this Agreement shall be decided in accordance with the laws of the State of Colorado. Jurisdiction and venue shall rest exclusively in Denver County, Colorado. Each party waives any and all rights to object to jurisdiction and venue in Denver County, Colorado. If any action at law or in equity is necessary to enforce or interpret the terms of this Agreement, the prevailing party shall be entitled to reasonable attorneys’ fees, costs and necessary disbursements in addition to any other legal or equitable relief to which such party may be entitled.

THE UNDERSIGNED REPRESENTS AND AFFIRMS THAT HE OR SHE HAS THE AUTHORITY TO BIND THE CUSTOMER AND/OR HAS BEEN GIVEN PROPER AUTHORITY BY THE CUSTOMER TO SIGN THIS CUSTOMER PROTECTION AGREEMENT AND ENTER INTO THIS TRANSACTION.

6. CUSTOMER SIGNATURE

Full Name:*

First NameLast Name

Business Name*

Title*

Signature*

Date*

Date

PLEASE NOTE:
All of the information herein is required before we can establish an account. Please ensure that this document is signed, dated, and filled out in entirety to avoid any unnecessary delays in our review process. If any of these documents are missing or incomplete, your account cannot be established.