Wholesale/Reselling InquiryPlease complete this form only if you operate a brick-and-mortar retail establishment. "*" indicates required fields Company Name*Contact Full Name* First Last Business Phone*Direct Phone*Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Resell Tax IDThis field is hidden when viewing the formResell Tax ID Shipping Address* Same as Billing Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Briefly explain why you would like to re-sell Sore No More® Pain Relieving Gels*Where do you plan on selling the Sore No More® products?*Brick & Mortar Company Website(s)Does your company sell to sub-dealers/wholesalers?* Yes No Does your company sell direct to Health Care Professionals?* Yes No *We highly recommend our Sombra® branded products, which are recognized as a premier private label within their industry. For more information, please visit www.sombraUSA.com.Does your company sell on any of the following 3PL platforms?* Amazon Craigslist eBay Jett Walmart.com Other Other*Please add the company name.*You are currently completing the incorrect application. Please visit our Ecommerce Distributor page for the appropriate form.EmailThis field is for validation purposes and should be left unchanged.
