Ambermed - Healthy & Wholesome lifestyle products
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Registration Form

To Become a Stockist, simply complete the below form: (* denotes mandatory field)

Retailer Type
Store Name/Group Name
Billing Address:
Contact Details
Delivery Address, where different from the billing address:
Are you VAT registered?
Where applicable, please attach a copy of your qualifications or studies here, in JPEG or PDF format (Students may attach a copy of their student ID):
Registering with Ambermed means that you'll be sent e-newsletters full of useful product information and emails about education seminars and promotional offers. Please opt in to receive these emails by checking the box below.