Wholesale Application : Bulk, Wholesale, & International : Herbs America Company

WHOLESALER'S APPLICATION

Appropriate for: practitioners, storefronts, internet retailers, product manufacturers, random volume buyers, tradeshow reps, & restaurants, etc.

Instructions & Notes: 1) Look over each question carefully and fill out the required fields that apply to your situation. (An asterisk ( * ) means field is required, otherwise, it's optional.) Please be generous with your information as this is the criteria we will need to approve your application. 2) Hitting the TAB key takes you to the next field. 3) Please double check all details before hitting the submit button at bottom of form. (submit only once please) 4) Please allow us some time to look over your application details before re-contacting us. Under normal circumstances, we will issue you a reply in less than 7 days. If we need additional information, we will contact you with the specifics.

General Information:
	Complete Name of Applicant:
First:	*
Last:	*
Postal Address:	*
City:	*
State / Province:	*
ZIP / Postal Code:
Country:	*
Phone:	*
E-mail:	*
Fax:
How did you find out about Maca Magic Products?	Website Retail Store Friend Other
Please describe in detail

Business & Account Experience/ Details:
Business Name:	*
Business Phone:	*
Business Fax:
Business Address:	*
City:	*
State / Province:	*
ZIP / Postal Code:
Country:	*
Website url:
Valid Business License #:	*
Valid Resellers License #:	*
Valid Practitioners License #:
Which of our products are you interested in purchasing:
Are you currently a wholesaler of any products? If yes, which ones?
Are you a manufacturer of any products? If yes, what are they?
What other brokers, distributors or manufacturers have you worked with before?
Briefly describe your plans for marketing Maca Magic Products:
Approximate volume of Maca products you foresee handling in your first year?
Do you attend trade shows, fairs, music, or cultural events? If yes, which ones?

Herbs America: Bulk, Wholesale, & International: Wholesaler's Application

WHOLESALER'S APPLICATION