Vendor Application Form

Harmony of Hearts Vendor Registration Form
Business Name
Contact Person:
Phone Number:
Email Address:
Preferred method of contact:
Website (if applicable:)
Type of Business:
Services Offered

Other
Short description of your services
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Service Area
Are you currently accepting new clients?
Open to cross-promotion/collaboration?
Willing to offer discounted packages for grieving families?
Do you have bereavement experience or sensitivity training?
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?
Do you have any certifications or special licenses?
Certifications or Special Licenses
Have you participated in any bereavement services before?
What dates are you available to provide your services?
Do you have any restrictions on the types of venues you can work in?
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.
Should be Empty:

Harmony of Hearts Vendor Registration Form