Wholesale Application

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PERSONAL INFORMATION
First Name:*
Last Name:*
Employee Title:*
Email:*
Work Phone:*
Mobile Phone:*
BUSINESS INFORMATION
Company Name:*
Company Website URL:
Street Address:*
City:*
State:*
ZIP Code*
How many years have you been in business?:*
What is your current number of employees?:*
Are you a...*
- Private Label/Bulk
- Farmer
- Wholesale/Reseller
Business Federal EIN/Tax Identification Number:
State Reseller Identification Number:*
What is your business structure?:*
What describes your business category?:*
What is your miscellaneous category?:*
What is your other miscellaneous category?:*
What is your natural type?:*
- INFRA
- NCG
- Other
Are you a USDA Organic Certified Farmer?:*
- Yes
- No
How many years has your farm grown hemp?:*
What is your total acreage?:*
Please enter a number from 0 to 1000000.
What is your total certified organic acreage?:*
Please enter a number from 0 to 1000000.
Is your store currently selling CBD?:*
- Yes
- No
What is the primary market you sell to?:*
What other markets do you sell to?:*
What products are you interested in?:*
Insert bulk product details:*
Insert other product details:*
Do you meet our minimum order value?*
What is your current monthly sales volume of hemp extracts?*
What is your annual company sales?*
QUESTIONS AND SCHEDULING
Where did you hear about RE Botanicals or Harmony?*
Is there any additional information you'd like to share with us?
LOGIN INFORMATION
The information you provide below will be used to create your wholesale account. Once you are approved you will be able to log into the wholesale website. We will notify you through E-mail upon approval.
Username*
Password*
Enter Password Confirm Password

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re botanicals

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harmony

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Disclaimer

This product is not for use by or sale to persons under the age of 18. This product should be used only as directed on the label. It should not be used if you are pregnant or nursing. Consult with a physician before use if you have a serious medical condition or use prescription medications. A Doctor’s advice should be sought before using this and any supplemental dietary product.

All trademarks and copyrights are property of their respective owners and are not affiliated with nor do they endorse this product. All of our products use industrial hemp that contains less than 0.3% THC. These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease. By using this site you agree to follow the Privacy Policy and all Terms & Conditions printed on this site. Void Where Prohibited By Law.

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