wholesale-application

1
First Name (Primer Nombre)* This field is required.
2
Last Name (Apellido)* This field is required.
3
Business Email (Correo de negocio Electrónico)* This field is required.Used for affiliate communication
example@example.com
4
Cell Phone (Teléfono Celular)* This field is required.for us to be able to text you
cell phone number
5
Business Phone (where clients can reach you)* This field is required.Teléfono de negocio
cell phone number
6
Necesita la aplicación en español?
SiNo
7
Esthetician/RN/MD License# State and Expiration DateIf you're not licensed, please state your profession.
8
Business Website* This field is required.not social media handle
9
Business Address* This field is required.for locator for clients
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
10
Are you taking new clients?* This field is required.please select
YESNO
11
Are you paperless?* This field is required.We can help if you are not. (handouts/waivers/etc)
YESNO
12
How did you hear about us or who referred you?* This field is required.
Google
Instagram
Yelp
Facebook
TikTok
Friend
Family
Doctor
Esthetician
Other
13
What is your current set up?* This field is required.Check all that apply
It's just me
I have employees
I have renters
I have an online store
I have marketing in place (email social etc)
I have receptionist
I see only acne clients
I see acne clients but offer other services
I don't acne clients but offer other services
Med Spa
Other
14
When is the best time to reach you?* This field is required.Please give a day of the week and a time window
15
What other product lines do you carry?* This field is required.Names of the product lines
Huge
Large
Normal
Small
Ok
Ok
16
You'll be receiving a few follow up emails from us with more information if you are approved.

ALL OF YOUR IMPORTANT DOCUMENTS, INSTRUCTIONS, LOGIN, ETC ARE SENT VIA EMAIL!

IF YOU UNSUBSCRIBE AND MISS IMPORTANT EMAILS YOUR ARE RESPONSIBLE! WE DON'T SPAM.

If you have any troubles or questions, please email us and we'll get back to you as soon as possible.

CLICK SUBMIT TO CONFRIM YOU have read the above and understand the instructions.
17
Is there anything you need help with? Is there anything else you'd like to share?Please type your questions, concerns or any information that is pertinent below.
please share your thoughts
18
Are your clients asking for anything you don’t currently offer?* This field is required.please note below
19
What skin concerns are you treating most often right now? * This field is required.check all that apply
Acne
Barrier repair
Pigmentation
Pro-aging
Other
20
When do you meet with staff or decide to bring in new products?* This field is required.date or time of year
21
Do you set aside a budget for retail, add-ons, or treatment enhancements?* This field is required.please select one option
No
Yes
Sometimes
Other
22
Who usually decides which brands or products to bring in?list below
23
What kind of education, resources, or support would make introducing a new line easiest for you? * This field is required.please select all that apply
training
product knowledge
marketing materials
hands on
facetime
Other
24
Your sales and use tax certificate for wholesale discountupload here
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
25
Select an Quick Onboarding Appointment TIMES ARE IN PSTIf you can't find a time that works please answer the next question
26
If you couldn't find a time that works for you please state a time & date belowgive a few options
27
Please verify that you are human* This field is required.
Should be Empty: