Wholesale Signup

Wholesale Application

Required fields indicated with an asterisk (*)

First Name*

Last Name*

Company

Address 1*

Address 2

City*

State/Province/Region*

Zip/Postal Code*

Country*

Daytime Phone*

Evening Phone

Daytime Fax

Tax ID/SSN*

Website URL

Where did you hear about us?

Login Information

Email*

Password*

Confirm Password*

Desired Pricing Level

Wholesale

Please describe your business, where our products will be sold, and any other pertinent information to your application.

UPLOAD YOUR SIGNED DISTRIBUTOR AGREEMENT AND SALES TAX CERTIFICATE HERE

Use the 'Choose File/Browse' button to upload your signed distributor agreement and sales tax certificate. You may also email or fax it to us via our contact page. If approved, we will send you a copy signed by us for your records. Please feel free to contact us with any questions or comments.

Agreement

Note, Fresh And Alive products are offered at wholesale prices to retailers with a valid sales tax certificate for the purpose of resale only. I certify that I am a bonafide reseller purchasing these products for resale. Violating this agreement will be considered a violation of our terms and your account will be terminated.

I have read, understand, and agree to the above agreement.*