US Jaclean Wholesale Retailer Request Form

US Jaclean Wholesale Retailer Request Form

Would you like to carry US Jaclean's products in your store? Let us know more about you and your business! Please allow 5 - 7 business days for requests to be reviewed.
As a note, in order to qualify as an authorized retail partner with US Jaclean, your business must:
- be based in and selling to customers in the US
- have a physical brick-and-mortar sales outlet rather than an online marketplace platform
We are currently NOT accepting dealers who only sell online. This form is only for those who wish to sell through a physical store (with or without an independent e-commerce site). Any retailer that does not meet this requirement will not be accepted.
Name of Business*
Main Contact Name*

First NameLast Name
Contact Title*
i.e. owner, manager, etc.
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shipping Address (if other than billing)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area Code Phone Number
E-mail*
Website
i.e. www.usjaclean.com
What year was your business established?*
i.e. 2020
Business Tax ID/Resale #: *
Number of Current Store Locations*

12-55-1010+
Which categories of products that we provide are you interested in carrying? Select all that apply.

Health & FitnessSmall Massage ItemsHolisitic WellnessHome, Kitchen, & GardenBeautyMassage Chairs
Tell us a little bit about your business*
A brief description of your business (what types of products you sell, customer base, etc).
After receiving your application, one of our Wholesale Team Members will review it and reach out via email. Once given notice of approval, payment and shipping options will be determined and a wholesale item and price list will be sent out to move forward with placing an order. Thank you for your interest in US Jaclean!
Should be Empty: