Company:

Company URL:

Contact:

Position in Company:

E-Mail Address:

Telephone Number:

FAX Number:

Street Address:

City:

State:

Postal Code:

Country:

Do you currently sell any all-natural beauty products?
Yes
No

Do you currently sell any all-natural health products?
Yes
No

How long has your business been in operation?
Not open yet, but will be within 3 months
Less than one year
1-3 years
3-5 years
5-10 years
Over 10 years

 What type of business do you operate?
health food store
spa
beauty salon
holistic health practice
ecommerce
Other (please explain here):  

Please tell us about your company and your products and/or services:

Your Retail/Resale Tax ID #:
This information is encrypted and will not be shared with anyone, although our vendors may eventually ask you for this.

Comments or Questions:

Special Discount Code (If applicable):
 

     Filling out this Membership Request Form does not constitute our acceptance of your company
for membership in our wholesale program.  Not all requests are accepted.  This form must be completely
filled out. Your information will be reviewed and you shall be sent an e-mail shortly.  If accepted, we will
send you to a Payment page where you may pay through PayPal. We sincerely thank you for your time, and interest in joining us.