HOME > Wholesale > Application Form

New Wholesale Account Application



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

Business Type:
brick-and-mortar
online
both
other (please specify):

Contact Person:
* REQUIRED

E-mail Address:
* REQUIRED

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

Telephone Number:
* REQUIRED

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#.


How did you hear about us?




Message for our team (optional):

 



 Please enter the following security
 code into the box provided:


 


  
  (letters are not case-sensitive)