Official Wholesale Application

Open A Professional Account
We have 2 types of wholesale partnerships available exclusively to licensed professionals.

1. Business Partnership: Backbar or Retail of Agent Rx Pro Products within your business. You will not be charged tax on your purchase. You will need a Sellers Permit OR live in a state that does not charge sales tax to avoid paying tax.

2. Licensed Esthetician: You do not own a business but would like to purchase products at a wholesale rate. You will be charged tax on your purchases in certain states.
Please read and agree to the statements below:*

I agree NO AMAZON SALES.I agree to the Wholesale Partnership Agreement and will adhere to the policies outlined to maintain my account status.Online sales are permitted at our suggested retail price. If selling for below MSRP your account may be frozen.
Click here to access the complete Wholesale Partnership Agreement.

If you have any questions, feel free to contact us at support@agentrx.co

Name*

First NameLast Name
Signature

Powered by Jotform SignClear
How will you be using or selling Agent Rx products?*

Online SalesIn-StoreBackbar
Choose your account type for tax purposes:*

I collect sales tax AND I hold a valid Sellers PermitI am a licensed Esthetician not a business ownerI live in a State without Sales Tax
Business Owner*

Account Type: Licensed Esthetician

You will receive wholesale pricing but pay tax on your purchase, even if you are in a state that doesn't charge sales tax. If you would like to avoid this please select a different account type on the previous page.
Licensed Professional*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1. Upload Esthetician License*

Browse Files
Must be a current license from your state. Cancelof
2. Upload Liability Insurance

Browse Files
If you have liability insurance. Cancelof
:: Important Account Info ::

After you click "SUBMIT" below, you will be asked to create an account on Shopify.

Fill in your information and save it for future orders.

Once you create the account, you can access pricing and place your first order.

Failure to complete this step will prevent you from ordering, and you will need to fill out the application again.

Thank you!

Account Type: States without Sales Tax

Upload business documentation below. You will not be charged sales tax on any purchase once approved.
Licensed Professional / Business Owner*

First NameLast Name
Email*
example@example.com
Business Name*
Business Address *

Street Address

Street Address Line 2

CityState

Zip Code
Upload Esthetician License*

Esthetician License
Must be a current license from your state. Cancelof
Upload Liability Insurance*

Liability Insurance
Must be a current policy. Cancelof

Account Type: States with Sellers Permit

Upload business documentation below. You will not be charged sales tax on any orders once approved.
Licensed Professional / Business Owner*

First NameLast Name
Email*
example@example.com
Business Address *

Street Address

Street Address Line 2

CityState

Zip Code
Upload Esthetician License*

Esthetician License
Must be a current license from your state. Cancelof
Upload Liability Insurance*

Liability Insurance
Must be a current policy. Cancelof
Upload Sellers Permit*

Sellers Permit
Must be a current permit from your state. Cancelof
:: IMPORTANT PLEASE READ ::

Once you click "SUBMIT," you will need to fill out the California Resale Certificate (This is for all states with a seller's permit.)

Follow the directions.

After you submit the CA Resale Certificate form, you will create an account on Shopify. Save this information for future orders.

If you do not complete these steps, you will need to fill out the application again.

Thank you!
Should be Empty:

Account Type: Licensed Esthetician