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Registration Form

To enable us to perfectly set up your range to your own customised liking, we require you to go over the following options and let us know how you would like us to create your own private label product, once all of your information has been submitted, we will provide you with your own personal login with access to ordering. All orders up to 500 units will be ready within 5 business days
BUSINESS DETAILS
CLINIC/BUSINESS NAME:*
ABN:
CONTACT PERSON:*
CONTACT PHONE NUMBER:*
CONTACT EMAIL:*
POSTAL ADDRESS (this is the address you want your orders sent to):*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
AS WE DO NOT PROVIDE PRODUCT TRAINING, YOU ARE REQUIRED TO HAVE COMPLETED YOUR OWN BASIC KNOWLEDGE IN SKINCARE, ARE YOU AN EXPERIENCED SKINCARE PROVIDER?*
- Y
PAYMENT DETAILS
THESE DETAILS WILL BE USED TO PROCESS PAYMENT FOR YOUR ORDERS:
CREDIT/DEBIT CARD #:*
Expiry Month/Year:*
CCV:*
KEEP ON FILE:*
- Y
- N (you will be asked to provide each time)
PACKAGING
PACKAGING:*
- WHITE AIRLESS MEDICAL GRADE PACKAGING (our recommended packaging)
- SILVER AIRLESS PUMPS
- SUPPLY MY OWN PACKAGING
Upload image of your Packaging to ensure it is suitable:
Accepted file types: jpg, gif, png, jpeg, Max. file size: 64 MB.
Once you have ensured your packaging is suitable for dispensing our products, please post your packaging to us at ACPHARM QLD, 24 Surfers avenue, Mermaid Waters QLD 4218. Please only provide the amount required as we are unable to store excess packaging on site
LABELS
Label Layout:*
- LAYOUT 1
- LAYOUT 2
- LAYOUT 3
- I Supply my own label design in a high definition PDF or PNG file for you to print
- I Supply my own labels on a printed roll for you to apply
- Please send my products nude, I will label them myself
PROVIDE YOUR CUSTOM LABEL INFORMATION
Once you have approved your label proof using the below details, a $5 fee will apply to all future label amendments (including but not limited to: change of logo/product name/description/address etc). Please confirm that all information provided below is to be used to create your label proof.*
- Y
Please upload your logo here
Drop files here or

Accepted file types: jpg, gif, png, jpeg, Max. file size: 64 MB.
Your ADDRESS to be displayed on label:
Your EMAIL to be displayed on label:
Your Website to be displayed on label:
What colour would you like us to design your label with?
- the same as my logo
- other (eg. NAVY blue, BABY pink, aqua etc)
other colour (eg: if blue- NAVY blue. BABY blue etc):
Would you like us to use our generic product name and description on your labels: (this information can be found under 'PRODUCTS' tab)
- YES
- NO (please provide details below)
Our product name:
Your product Name (what you want to call your product):
Your Product description: (the product description you wish to have on the front of your bottle)
Our product name:
Your product Name:
Your Product description:
Our product name:
Your product Name:
Your Product description:
Our product name:
Your product Name:
Your Product description:
Our product name:
Your product Name:
Your Product description:
Our product name:
Your product Name:
Your Product description:
Our product name:
Your product Name:
Your Product description:
YOU HAVE NOW COMPLETED YOUR BUSINESS AND PRIVATE LABEL PRODUCT REGISTRATION. You will be contacted within 24-48 hours with your label proof and online shop login details.
Thankyou! That is all we need from you for now, please click submit to have your account set up and start ordering

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LOGIN OR NEW CUSTOMER APPLICATION

Ready to start designing your own Private Label Skincare range? Click "NEW CUSTOMER APPLICATION" to provide your customised packaging, product and label selections