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Please provide credit references OR credit card details in the spaces below - your application can not be processed unless one of these sections is completed.
Please note references cannot include utility providers (ie power, phone etc) or banks. Please ensure they are aware we will be calling and that they are authorised to discuss your account with us.
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I understand and agree that all orders made and all goods supplied by Phytomed Medicinal Herbs (Phytomed), are made and supplied subject to the attached terms & conditions of sale and understand all prices are exclusive of GST and are subject to change at Phytomed's discretion. All information provided is true. I authorise a representative of Phytomed to discuss my credit history with the contacts provided, or any other person which Phytomed may consider necessary in the course of its business, including credit assessment, debt collecting and direct marketing activities.
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