First name*

Last name*

Company name*

Address Line 1*

Address Line 2

City*

State*
—Please choose an option—WyomingCaliforniaNew YorkWest VirginiaWisconsinWashingtonOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermont

Zip code*

Company website*

Email*

Phone number*

What is the primary nature of your business?*
—Please choose an option—Physical RetailEcommerce ResellerDistributorPersonal/Business UseOthers

What type of business do you have?*
—Please choose an option—DistributionCommercial Real EstateConvenience StoreE-CommerceEducation CenterGas StationGeneral StoreGrocery StoreHardware StoreHotel or Motel Medical PracticeMini MartPet StorePharmacyRestaurantSchoolSpecialty StoreUniversity or CollegeOthers

How many locations do you purchase for?*
—Please choose an option—12-55+

Reseller Certificate

Please share your state-issued reseller certificate in order to be eligible for tax-exempt status. Don't have a reseller certificate? That's fine. You'll still be able to purchase from The Beauty Impact at wholesale prices.