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Business Name

Contact Person

Contact Person Title

Contact Person Email

Contact Phone Number

Business Phone *

Business Website

Business Address

Shipping Address

Briefly Explain Your Business

What is your Primary Business? brick and mortar retail boutique spa/salon hotel retail gym/fitness studio floral shop department store ecommerce store subscription box Other

How Will You Sell REVIVE Products? In-Store Online In-Store and Online Other

Have you used REVIVE products in the past? Yes No

Do you plan on selling REVIVE online? Yes No

What other bath/body brands do you carry? *

How did you discover REVIVE products? *

What are your social media handles? *

Number of years in operation? *

Anything else you would like to share?

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