Wholesale Account Application
Sign in to Google to save your progress. Learn more
Email *
Your Full Name *
Your Business Name *
Business Address *
Business Number *
Federal Tax ID No. *
Website *
If your business is located in CT, do you have a Sales Tax License? If you do, please make sure to email it to us at community@healerswhoshare.com
Clear selection
How long have you been in business? *
Have you personally experienced the HWS waters? If you have please tell us how you came about using them? Who shared the waters with you and what was your experience using them?
Please tell us about your practice *
What services do you offer? *
What type of client do you serve? You may have a specific avatar or it can be broad. Where are most of your clients located?
Do you offer coaching services? If so, do you offer different types of packages of services? 
How will you integrate the HWS waters into your practice? *
Are you planning an event and want to incorporate the waters?
Clear selection
If yes to planning an event, please tell us more about it.
Do you have a physical retail store or an online store?
Clear selection
Are you interested in customized waters?
Clear selection
Do you have a program that you intend to incorporate the waters into?
Clear selection
If you do have a program, please tell us more about it.
Do you offer your clients an introductory package? If you do, please tell us more about it.
Have you joined our newsletter? *
Have you joined our free community calls? *
Are you interested in becoming a HWS practitioner? *
Are you planning on taking HWS education classes to better understand our waters? To see a list of webinars that are offered, copy and paste this link into a browser: https://healerswhoshare.com/hws-webinars/
Clear selection
If you are on social media, please share your social media handle names below.
Would you like to utilize social media in your work with the HWS waters?  *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms