Wholesale Membership Application

Wholesale Membership Application

Thank you for your interest in becoming a Wholesale Partner with A Blend of Health. Please complete this application in full. Applications are reviewed within 5–7 business days. Upon approval, you will receive access to our wholesale pricing and ordering portal.
Business Name *
Business Type | Select at least one*

Restaurant / CaféJuice Bar / Smoothie ShopRetail StoreGym / Wellness CenterCorporate OfficeDistributor
Tax ID / EIN / Reseller Permit #
Website / Social Media
Primary Contact Information

First NameLast Name
Personal / Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Ordering & Volume Estimates
Estimated Monthly Order Volumes:

$250 - $499$500 - $999$1,000+
Preferred Ordering Method:

Online Wholesale PortalEmail Order Form
Preferred Fulfillment Method:

Local DeliveryPickupRefrigerated Shipping
Business Verification

Attach your business license | Reseller Permit | Other Verification Documents
Cancelof
Terms & Conditions

By signing below, I acknowledge and agree that:
1. All wholesale orders are for business use or resale only.
2. Minimum order requirements apply ($250 opening, $150 reorders).
3. Juices must be handled and stored according to provided guidelines.
4. Payment terms must be followed (credit/debit, ACH, or approved net terms).
5. Wholesale pricing and account privileges may be revoked at any time for failure to comply with program rules.
Signature

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Date

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Wholesale Membership Application

Ordering & Volume Estimates

Terms & Conditions