Master Data - HCK Micronutrients

To enable us to process your registration for the new FAS, please complete the following form in full.

Company

First Name

Name

Street and House Number

City

State / Province

ZIP / Postal Code

Country

Email Address

Phone

How did you hear about us?AdvertisementInternet

Recommendation by / Other:

Industry(10) Doctor, dentist with professional / practice licence incl. self-dispensation licence (CH only)(20) Doctor, dentist, chiropractor with professional / practice licence(30) Medical professionals such as naturopaths, certified naturopaths, nutritionists, health coaches, natural health doctors, alternative practitioners(40) Pharmacy with retail licence for the pharmacy (CH) or pharmacy operating licence (DE/EU)(50) Drugstore with operating licence (CH only)(60) Pharmaceutical company with manufacturing / trading licence for medicinal products (all categories)(70) Other trade without medicinal products, e.g. food trade – no licence required(90) Paramediform business customer – no licence required

Publication on the Hepart AG websites (Hepart & HCK). As a reseller, I agree to be publicly listed on the Hepart AG website in the postal code search engine as a distribution partner and part of the Hepart network.YesNo

Licence / Permit (Upload File)

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Please upload a copy of your licence / permit (practice, trade, operating, manufacturing, etc.) with this form.

I agree that my customers may be accompanied by Hepart AG with emails during the purchase and re-order process.YesNo

To enable us to process your registration for the new FAS, please complete the following form in full.

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