Home > Wholesale > Application Form

Wholesale Account Application Form


LupineThank you for your interest in LüSa Organics! We are currently accepting applications for new wholesale partnerships.

Important: In order to apply for a wholesale account with LüSa, you must first have a customer account.

Create a customer account now

After you have created a customer account, fill in all requested information below, then click the SUBMIT button.

LüSa will contact you within 3 to 4 business days to confirm your approval status.

Business Name:  

Contact Person:  

Telephone Number:  

E-mail Address:  

NOTE: E-mail address submitted above must match e-mail address used in your customer account registration.

Resale Exemption Tax ID Number:   * REQUIRED

NOTE: This is required for wholesale account approval for Wisconsin customers. This number, aka Sales Tax Account Number, is on your Wisconsin Reseller's Permit. It is NOT your EIN#.


Lupine (pictured above) asks, "How did you hear about us?"

existing retailer
Dane County Farmers' Market
customer referral
internet
"Clean" - The LüSa Organics Blog
Skin Deep Cosmetics Database
Mothering Magazine
SouleMama
Sew Liberated
Diaper Pin
news article or media
other (please specify):



Message (optional):

 



 Please enter the following security
 code into the box provided:


 


    (letters are not case-sensitive)