Wholesale / Retailer Application Form

If you are interested in being a Wholesaler or Retailer for Intuition products, please fill out and submit this simple online form! We will be in touch with you as soon as possible!

 

Click Here for a Downloadable Version!

Business Information

   
Store Name
 
Shipping Address
 
City
 
State / Province
 
Postal Code
 
Country
 
 

Contact Information

   
Contact Name for Orders
 
Contact Phone Number
 
Contact Email
   
Contact Name for Invoicing (If different from above)
 
Contact Phone Number (If different from above)
 
Contact email (If different from above)
 
 

Trade References (To establish terms):

Trade Reference #1:

 
Company
 
Your Account #:
 
Contact Name
 
Phone / Email
   

Trade Reference #2:

 
Company
 
Your Account #:
 
Contact Name
 
Phone / Email
   

Trade Reference #3:

 
Company
 
Your Account #:
 
Contact Name
 
Phone / Email
 
 

Intuition will contact you directly for credit card payment options!

 
 
   

Feel free to include any questions, comments or other info here!