Bombshell x BioSkin Verification Form
Customer Name
*
First Name
Last Name
License #
*
Business Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com (NOTE: INVOICES WILL BE EMAILED TO THIS EMAIL ADDRESS)
Are you a current client of BioSkin Aesthetics?
*
Please Select
Yes
New Client
Shipping Address-
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your billing the same as your shipping?
*
Please Select
YES
NO
Billing Address-Enter if different than your shipping
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional shipping fees may apply to certain states/countries. Please ask your rep for details.
US customers ONLY MUST present Tax Resale certificate to have tax WAIVED on order. IF YOU ARE NOT IN AN APPLICABLE STATE, *DISREGARD*
Please Select
Yes
No
Not Applicable
Previously uploaded
Failure to send certificate will result in applicable state tax being charged on your order.
Resale Certificate Upload
Browse Files
Drag and drop files here
Choose a file
Should you need an example, please reach out to your representative
Cancel
of
ORDER additional request and or notes:
I,
First Name
*
Last Name
*
hereby acknowledge my understanding that there are no refunds, returns, or exchanges on any Bioskin Aesthetics product, unless otherwise authorized by the Bioskin Aesthetics management, in writing.I am authorizing this purchase with full knowledge of this policy.
Signature
*
Submit
Should be Empty: