Let’s work together Business Information Business Name * Doing Business As (DBA): (If applicable) Business Type * Retail Store Online Retailer Boutique Spa/Salon Other If "other", please specify: Website http:// Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Mailing Address: (If different from physical address) Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * Country (###) ### #### Email * Tax ID/EIN * Years in Business Contact information Primary Contact Name * First Name Last Name Title/Position Phone (###) ### #### Email Wholesale Interest Products of Interest * Yoni Steam Respiratory Steam Muscle Rub Marigold Salve Elderberry & Rosehip Tincture Agua de Florida Calendula & Chamomile Face Oil All Estimated Order Volume * $0-$500 $500-$1000 $1000-$5000 $5000+ Estimated order Frequency * Monthly Quarterly Annually Other Thank you!
