P.O.   Box   25  Dover,   Idaho  83825  

(844)   811-­‐4584      

 

FILL  OUT  ALL   SECTIONS  TO  AVOID  DELAYS   -­‐   FAX  TO   1-­‐800-­‐927-­‐1765   Date   /   /        

   

   

 WE PROMISE THE THORNE EXPERIENCE WILL INCLUDE: A  friendly,  well-­‐trained  customer  service  staff  available  Monday  through  Friday,  6:30  am  to  5:00  pm  PT  to  process  orders  and  answer non-technical questions; prompt technical support from a qualified staff of physicians; swift, reliable shipments (for free  shipping  rates  see  Professional  Order  Form  or  contact  Customer  Service);  quantity  discounts;  and  an  informative  website  for  physician  education,  product  information,  and  placing  orders  24/7.  

 

OFFICE USE ONLY

CUSTOMER SERVICE - PRINT CLEARLY TO AVOID DELAYS

         

         

                           

Suite              

                           

                                               

                                                                                                         Degree(s)

       

Reseller            

Please   select   payment   type:     MasterCard      

     

Expiration  Date   Cardholder  Name          

Accounts    Payable  Contact     Phone   )      

Employees authorized to change company info AND place orders - please check the box that applies:

 

           

           

 MINIMUM ORDERS: $30.00  minimum   order.  

 

 SHIPMENT DISCREPANCIES: If  a  discrepancy  exists  between  the  quantity  or   items  ordered,  and   the  quantity  or   itemsreceived,  please   notify  Thorne  Research  within   3   business  days   of   receipt   of   the   shipment.  

Listing or License Verification Not in DB I In DB Set-Up I I

Comments                        

Information   taken  from       CS  Rep     Date   /            Account    

Approved     Yes   /  No   By     Entered  By       Date   /    

Customer  Account      Number           Sales   Person