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:   * REQUIRED

Contact Person:   * REQUIRED

Telephone Number:   * REQUIRED

E-mail Address:   * REQUIRED

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
"Clean" - The LüSa Organics Blog
Skin Deep Cosmetics Database
Mothering Magazine
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)