Vendor Application Form

Harmony of Hearts Vendor Registration Form
Business Name
Contact Person:
Phone Number:
Email Address:
Preferred method of contact:

PhoneEmailText
Website (if applicable:)
Type of Business:
Services Offered

FloristPhotographer/VideographerGrief Counseling / TherapyCatering / RefreshmentsMusicians or VocalistsMemorial Program Design / PrintVenue / Chapel SpaceTransportationClergy / Spiritual LeadershipOther
Short description of your services
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Service Area*

Apache JunctionAvondaleBuckeyeBullhead CityCamp VerdeCasa GrandeChandlerCoolidgeCottonwoodDouglasEl MirageFlagstaffFlorenceFountain HillsGilbertGlendaleGoodyearKingmanLake Havasu CityLaveenLitchfield ParkMaranaMaricopaMesaNogalesOro ValleyPageParadise ValleyPeoriaPhoenixPrescottPrescott ValleyQueen CreekSaffordSan LuisScottsdaleSedonaShow LowSierra VistaSurpriseTempeTollesonTucsonWinslowYuma
Are you currently accepting new clients?

YesNo
Open to cross-promotion/collaboration?

YesNo
Willing to offer discounted packages for grieving families?

YesNoConditional
Do you have bereavement experience or sensitivity training?

YesNo
If you answered "Yes" to the above question, please provide a brief description.
Upload any promotional materials or sample work below
Email any additional photos/work to harmonyofheartscare@gmail.com with your business name in the subject field.
Are you licensed and insured?

YesNo
Do you have any certifications or special licenses?

YesNo
Certifications or Special Licenses
Have you participated in any bereavement services before?

YesNo
What dates are you available to provide your services?
Do you have any restrictions on the types of venues you can work in?

YesNo
Additional Information
Please provide any additional information about your business or services that you think would be helpful:
I agree to be contacted by Harmony of Hearts for potential collaboration.

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Harmony of Hearts Vendor Registration Form

Upload any promotional materials or sample work below

Additional Information