• SECTION 1, Company info:

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  • SECTION 2, Owners/Officers of Company:

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  • SECTION 3, Current Business References:

  • List only open accounts from whom you currently buy products.

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  • SECTION 4, Credit Card Authorization:

  • For your convenience, we accept credit card payments by phone. However, we are no longer allowed to keep your credit card info on file. To expedite your order, please include your credit card number, expiration date, CID code, and billing zip code on all faxed or emailed orders. Be prepared to give us your credit card information each time you order by phone

     

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  • You must email us a copy of your Business License and State Sales Tax certificate after submitting this form. Email to info@GaiasWorld.com.

     

    After we receive your license and certificate we will email your login information.

    Thank you, Gaias World Ceremonial Herbs®.

     

    Hit the 'Submit Info" button below to send this form.

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