Wholesale Application Form

Wholesale Application
Thank you for your interest in carrying Mudology Skincare in your store! Please fill out the application below & submit. We will contact you within 48 hours. Feel free to reach out at sales@mudology.com or (250) 888-5689.
Name of Business
Legal NameDBA or AKA
Shipping Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Is this a Residential Address?
YesNo
Phone Number*
E-mail
example@example.com
Primary Contact
First NameLast Name
What Type of Business are you?
Retail StoreSpaOther (please specify in Notes)
Number of Employees (So we know how many samples to send!)
How did you hear about us?*
Notes / Anything else we should know about your business?
Signature
Clear
Date
MonthDayYear
Date
Terms & Conditions: All information collected is confidential. No payment information is kept on file, all invoices are able to be paid online through a secure site (if paying by cheque, please let us know). First order is payable immediatley, all orders after are on 30 days terms from receipt of product.
Should be Empty: