Distributor Registration Form

Join our Wellness Partners network by completing the Distributor Registration Form and help share Shazai’s natural remedies with your community.

Name

First

Last

Phone

Mobile

Confirm Email

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

How did you find out about us?

Additional Information

Are you currently employed?

Type of Job

Are you self employed?

What Business?

Government Issued Identity Document

Drag & Drop Files, Choose Files to Upload

Government Issued ID*

Security Check