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?
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Primary Contact
First NameLast Name
What Type of Business are you?
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: