Retailer Application Form

Retailer Application

To apply for retailer/reseller please complete all questions.
Name*

First NameLast Name
Cosmetology License Number*
Upload an image of cosmetology license*

Browse Files

Cancelof
Business Name (DBA)*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Cell Number*

Area CodePhone Number
Work Number

Area CodePhone Number
Website*
Which hair extensions would you be interested in?*

BundlesPonytailsClip-In ExtensionsClosures
Signature

Clear
Signature Date

MonthDayYear
Date
Should be Empty: