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Interested in becoming a Vital Leaf Wholesale Partner? Please register by completing the form below. We’ll be in contact with you shortly on next steps.

Register for a Vital Leaf Wholesale Account

First Name(Required)

Last Name(Required)

Job Title(Required)

Business Name(Required)

Business EIN

Business State Reseller’s License

(Required for all states except AL, CO, DE, MS, MT, NH, OR)

Business Website(Required)

Business Phone Number

Billing Address(Required)

Billing Address Line 2

Billing Town/City(Required)

Billing State(Required)

Billing Postcode/Zipcode(Required)

Business/Shipping Address

(if different than Billing Address)

Full Name of Accounting Point of Contact(Required)

Email of Accounting Point of Contact(Required)

How did you hear about us?

Search Engine

Social Media

In Store

Website Article

Recommended by Friend/Family

Other

Would you like to be added to our Store Locator?

Yes

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