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WHOLESALE
GENERAL INFORMATION
Fields marked with an asterisk (*) are required.
First Name *
Last Name *
Name of Company / Business *
Name of Boutique, spa, etc. if different from
Company / Business Name
Job Title / Funtion
Phone Number * / (###-###-####)
Fax Number
Email Address *
Website
Tax ID Number of FEIN Number *
Resale ID Number *
You will be required to mail or fax a copy of your resale ID certificate.
RETAIL STORE ADDRESS AND CONTACT INFORMATION
Contact Name / Store Manager *
Address Line 1 *
Address Line 2
City *
State *
Province
Country *
Zip/Postal Code *
Phone Number *
(###-###-####)
Fax
Email Address *
THANK YOU!
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