Greenhealth Approved Application

Contact Information

Instructions:

Please complete the entire form and upload the excel file with your product information if you are prompted to do so. The spreadsheet can be found under the associated product category on our website greenhealthapproved.org. Incomplete forms cannot be processed and will delay our ability to respond to your request.

1. Contact Information

First Name *This question is required.

Last Name *This question is required.

Title *This question is required.

Company Name *This question is required.

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Zip

Email Address *This question is required. This question requires a valid email address.

Phone Number *This question is required.

URL *This question is required.

State of Incorporation

How did you hear about Greenhealth Approved? *This question is required.

Do you have the legal authority to sign the vetting and licensing agreements? *This question is required.

Please provide authorized signer information

Name

Title

Email Address