Wholesale Instructions & Information:

To apply for a wholesale account for online ordering, please fill out and submit the form below. Fields marked with an asterisk (*) are required.
Please be sure to provide us with a valid email address so that we can notify you once your account has been approved and activated.
We require that your first wholesale order be a minimum of $150.00.

Please Note: After filling out the application you will receive a confirmation email with your account details. However, you will not be able to access wholesale information, such as wholesale pricing, until you receive a notification stating that your wholesale account has been ACTIVATED.

Your e-mail address must be valid. We use e-mail for communication purposes (order notifications, etc). Therefore, it is essential to provide a valid e-mail address to be able to use our services correctly.

All your private data is confidential. We will never sell, exchange or market it in any way.

User account

Account information

Username: *

Your preferred username; punctuation is not allowed except for periods, hyphens, and underscores.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

1 Business Information

Business Name: *

Enter your business name The content of this field is kept private and will not be shown publicly.

State Resale Tax ID Number: *

Enter your State Resale Tax ID Number The content of this field is kept private and will not be shown publicly.

Business or professional license: *

Enter your business or professional license The content of this field is kept private and will not be shown publicly.

Website URL:

The content of this field is kept private and will not be shown publicly.

2 Personal Information

First Name: *

Enter your first name here: The content of this field is kept private and will not be shown publicly.

Last Name: *

Enter your last name The content of this field is kept private and will not be shown publicly.

Address 1: *

The content of this field is kept private and will not be shown publicly.

Address 2:

The content of this field is kept private and will not be shown publicly.

City: *

The content of this field is kept private and will not be shown publicly.

State: *

The content of this field is kept private and will not be shown publicly.

Zip Code: *

The content of this field is kept private and will not be shown publicly.

Phone: *

The content of this field is kept private and will not be shown publicly.

Fax:

The content of this field is kept private and will not be shown publicly.

Comments:

The content of this field is kept private and will not be shown publicly.

Preferred Contact Method: *

The content of this field is kept private and will not be shown publicly.

3 Additional Information

How did you hear about De La Terre Skincare?: *

The content of this field is kept private and will not be shown publicly.

Will you be selling De La Terre Skincare online?: *

The content of this field is kept private and will not be shown publicly.