Stockist Sign-Up Form

Stockist Sign-Up Form
Business Information
Business Name*
Business Type*

Hair SalonSpaPharmacyCosmetic RetailerOther
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country*
Contact Information
Contact Person's Full Name*

First NameLast Name
Contact Person's Position*
Phone Number*
E-mail*
example@example.com
Business Details
Years in Business*
Number of Locations*
Number of Employees*
Website URL*
Social Media*
Social Media ID*
Product Interest
Interested Product Lines*

ShampooConditionerHair MaskScalp Treatments SerumScalp Treatments Tools
Current Brands Stocked*
Monthly Product Sales Volume*
Additional Information
Reason for Interest in Odjibik Hair Repair Products*
How Did You Hear About Us*

Google SearchInstagramTikTokYouTubeFacebookSalon or Stylist RecommendationBlog or Online ArticleOther
Any Other Relevant Information*
Should be Empty:

Business Information