SAM's Apothecary Wholesale Application
Please fill out this application for consideration. We will get back to you that we have received it, and then again when a decision has been made. Thank you for your support!
Email address *
Legal business name & DBA *
Your answer
Business Website (or enter "NA")
Your answer
Business Facebook Page (or enter "NA") *
Your answer
STATE Business License # *
Your answer
STATE where business license issued from *
Reseller Permit Number (OR "SAME AS LICENSE) *
Your answer
Your Name *
Your answer
Your Position (If not the owner, manager, or buying manager, please also enter their name and contact number in the next question) *
Your answer
Owner or manager contact information if you are not that person.
Your answer
Your Phone Number *
Your answer
Billing Address (### & Street) *
Your answer
Billing Address (City, State, & Postal Code) *
Your answer
Shipping address IF DIFFERENT THAN BILLING ADDRESS
Your answer
Special Shipping / Delivery Instructions
Your answer
What interests you about carrying the SAM's Apothecary line of products? *
Your answer
Please acknowledge that White Sage sourcing is important, and that you strive to provide only ethically sourced White Sage. *
Please acknowledge that Palo Santo is over harvested and not ethical.
What is the population of your town/county/market area? *
Your answer
How many business within 50 miles do what you do? *
Please understand that if there is another business within the 50 miles that already carries SAM's products, your application will be further reviewed, and potentially held until such time as they either no longer carry them, or our exclusivity policy is changed. *
All of our products are infused with Reiki healing energy. Time, effort, and love goes into every batch of every product. Please acknowledge that our products aren't 'just another product on the shelf'. *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of SAM's Apothecary LLC. Report Abuse