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WHOLESALE APPLICATION
Minimum Purchase Requirements:
*
Eligibility for wholesale requires purchase of a minimum of four cases per year. Each case contains 12 bottles of 1000 MG Full Spectrum CBD Oil. Is this a requirement your company anticipates to meet?
Yes
No
Company Name* and DBA (if applicable):
*
Name of Owner/Partner/Officer:
*
Phone of Owner/Partner/Office:
*
Business Type:
*
Please Select
Corporation
Limited Liability Company (LLC)
Partnership
Sole Proprietor
Date Established:
*
Date Format: MM slash DD slash YYYY
Billing Country:
*
United States
Billing Address Line 1:
*
Billing Address Line 2:
Billing City:
*
Billing State:
*
Billing Zip/Postal Code:
*
Primary Contact:
*
Please Select
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Prefix
First
Last
Primary Contact Title:
*
Primary Contact Email:
*
Primary Contact Phone:
*
Primary Contact Alt Phone:
Primary Contact Fax:
Preferred Method of Contact:
*
Please Select
Phone
Email
Fax
Please provide the best time to reach you by phone. This should be a time when you have a minimum of 30 minutes of uninterrupted time to discuss your wholesale application.
From:
*
:
HH
MM
AM
PM
To:
*
:
HH
MM
AM
PM
Federal Tax ID (Optional):
Describe your business:
*
Tell us what people, products and/or services make you unique in your industry.
Do you sell products to the general public?:
*
(hold down CTRL key and click to select multiple options)
To the General Public (physical store)
To the General Public (online)
Private Office - Patients Only
Other
Do you sell products on eCommerce sites like Amazon.com, eBay, Jet, etc.?:
*
Yes
No
If Yes, list the name(s) of each store as listed on each site:
List each physical address for all locations where you intend to sell C4 Healthlabs products:
*
List each website link where you intend to sell C4 Healthlabs products:
*
If none, type N/A in the box.
How did you hear about C4 Healthlabs?:
*
Describe Other Products You Sell:
*
If none, type N/A in the box.
Describe Services That You Offer:
*
If none, type N/A in the box.
Select the marketing methods you use to promote products:
*
(hold down CTRL key and click to select multiple options)
Product Demonstrations
Brochures
Posters/Displays
Email
Internet
Personal Consultation
Other
None of the above
If other, please describe:
Please describe the marketing method you use to promote your products or services.
What support tools would enhance your efforts in promoting C4 Healthlabs?:
*
If none, type N/A in the box.
Please attach a copy of your Business License AND Sales Tax Permit/Resale Certificate (Optional):
Drop files here or
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