Professional Wholesale Inquiry Form

Essential Apothecaries and its Brands

Submit any inquiries to us by email: [email protected]

Visit our website for product details. https://www.EssentialApothecaries.com

Contact Information

Full Name *

Business Name *

Website (If Applicable)

Email *

Phone *

Target Launch Date *

My business is a: *

Headspa / Spa

Salon / Studio

Barber Shop

Other (Please specify below)

Describe Other Business Type:

I am a licensed: *

Cosmetologist

Esthetician

Barber

Other (Describe your role if you are a manager, buyer, etc.)

Describe your role if Other:

What state are you licensed in? *

My State License Number: (If you are a manager or buyer, you may use your resale number) *

Expiration / Renewal Date of your State License or Resale Number: *

If your Renewal Date is within 6 months, you will need to send us a new copy to keep your wholesale account active. If your State or County RESALE Number does not expire, enter No Expiration in the box.

PRODUCT INTERESTS - Skincare and Body Care Needs: (Select All That Apply) *

Face Cleansers and Cleansing Oils

Face Oil / Serums

Moisturizers

Tallow Balms, Butters, Whips

Vegan Body Butters & Balms

Masks / Exfoliating

Massage Oils

Hair and Scalp Oils

Dry Shampoo (clean and healthy hair) Options

Scalp Powder Mixes

Product Type *

Acne / Sensitive Skin Options

Dry / Mature Skin / Aging

Pregnancy Safe Options

Vegan Options

Essential Oils (EO) are Okay

NO Essential Oils (EO) / Unscented

Help me with EO understanding to make a good decision for my client base.

What is your interest? *

Back Bar

Carrying Retail Products for Client Purchase

Both Back Bar and Retail Products

Who is your target market? *

Women's Skincare Only

Men's Skincare Only

Both Women's and Men's Skincare

Give us details to any questions on the form, or ask us questions about any information you need. If none, type NONE in the box. *

Please Upload a clear and full view photo of your Current and Valid Resale License or Pro License for Wholesale Pricing *