Authorized Reseller Website Registration Form

Basic Brands, Inc. Authorized Reseller Website Registration Form

If you purchase Basic BrandsTM, Basic OrganicsR, Harvest of NatureR, Powerall®, Cleanz- Blendz, EyeScience®, Pura SaludTM Lipz PharmaCareR. NeuroActivesTM, and/or AchieveR products ("Products") from an Authorized Distributor of Basic Brands, Inc. ("Basic Brands") for purposes of resale to end users, you must register your website with Basic Brands in order for that website to be considered a "Permissible Public Website" under the terms of Basic Brands'

Authorized Reseller Policy for the United States. Please be advised that authorization to sell the Products on any website other than your own, proprietary website (e.g., as a third-party seller on Amazon, eBay, or Walmart Marketplace) is not granted via this registration form.

To register your website, please (1) fill out the Authorized Reseller Website Registration Form below, (2) review the terms in the Basic Brands, Inc. Authorized Reseller Policy for the United States, including the Online Sales Guidelines attached as an exhibit (the "Reseller Policy" and (3) click SUBMIT.

By completing this registration process, your website will be considered a "Permissible Public Website," and you will be authorized to sell Products through such website unless you are notified by Basic Brands that your authorization has been revoked. This registration process and the Reseller Policy are applicable only in the United States.

Fields marked with an asterisk are required.

COMPANY INFORMATION

COMPANY'S LEGAL NAME *

COMPANY'S DBA/TRADE NAMES (IF ANY)

COMPANY ADDRESS *

COMPANY ADDRESS 2

COMPANY CITY *

COMPANY STATE *

COMPANY ZIP CODE *

COMPANY EMAIL ADDRESS *

example@example.com

COMPANY PHONE NUMBER *

ENTITY TYPE (e.g., corporation, limited liability company, sole proprietorship) *

STATE OF INCORPORATION/ORGANIZATION *

EIN/TAX ID *

FIRST NAME *

LAST NAME *

POSITION AT COMPANY *

EMAIL ADDRESS *

example@example.com

PHONE NUMBER *

1. PLEASE IDENTIFY THE URL FOR EACH WEBSITE WHERE YOU INTEND TO SELL THE PRODUCTS. *

*Please review the restrictions on online sales described in the Reseller Policy carefully. You are only permitted to sell Products on a Permissible Public Website, which is a website operated by you in your own legal or registered fictitious name, states your contact information conspicuously, does not give the appearance that it is operated by Basic Brands or any third party, is operated in compliance with Basic Brands' Online Sales Guidelines, (which are an exhibit to the Reseller Policy) and is registered with Basic Brands through this Form. The Reseller Policy prohibits Authorized Resellers from selling on third-party marketplace websites such as Amazon, eBay, and Walmart Marketplace without Basic Brands' prior written consent. Consent to sell on third-party marketplace websites is not granted through this registration process.

2. DO YOU INTEND TO SELL THE PRODUCTS IN BRICK-AND-MORTAR RETAIL LOCATIONS? *

YES NO

PLEASE IDENTIFY THE PHYSICAL ADDRESSES FOR ALL BRICK AND MORTAR LOCATIONS WHERE YOU INTEND TO SELL THE PRODUCTS. *

FROM WHICH AUTHORIZED DISTRIBUTOR(S) DO YOU PURCHASE THE PRODUCTS? *

4. DO YOU INTEND TO STORE YOUR INVENTORY OF THE PRODUCTS AT A LOCATION OTHER THAN THE COMPANY ADDRESS IDENTIFIED ABOVE? *

YES NO

PLEASE PROVIDE THE ADDRESSES FOR ALL LOCATIONS WHERE YOUR INVENTORY WILL BE STORED:

By typing your name in the below box, I agree, on behalf of the company, as follows:

1. Company shall abide by the Basic Brands, Inc. Authorized Reseller Policy for the United

2. Company understands that it is strictly prohibited from using Basic Brands' name, logos, trademarks, copyrighted materials, and any other intellectual property in any way other than that granted in the Reseller Policy without the express, prior written consent of Basic Brands or its licensors in each instance.

3. Company affirms the information provided in this Authorized Reseller Website Registration Form is true, accurate, and current.

PRIMARY CONTACT PERSON: