Wholesale Intake Form

Thank you for your interest in becoming one of our wholesale retail partners! We value our wholesale accounts dearly and we are always here to provide support for you. We have educational/marketing materials available, including a brochure and postcards for each product line. You are always welcomed to ask for them. Please give our team 1-3 business days to review your application and send you your customized approval email.

Please let us know if you have any questions!

Legal Business Name(Required)

Business DBA (If Applicable)

Tax ID/EIN

Part of what we need for Sales Tax Exemption. If you do not want to share, that's okay! However, we will have to charge your state's sales tax.

Primary Account Contact Name(Required)

First Name Last Name Position/Role

Primary Account Contact Email(Required)

Primary Account Contact Phone Number(Required)

AP / Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

On-site Store Contact Name

(If different from Primary Account Contact)

First Name Last Name Position/Role

Store Phone Number(Required)

Store Shipping Address

(If different than Billing Address)

Street Address Address Line 2 City State ZIP Code

Website

Company / Store Instagram Handle

Please list any additional email contacts you would like copied on order information (Max 3)

Do you currently carry CBD products?

Yes

Do you plan to sell our products online?(Required)

Yes, Right Away

Maybe/Not Sure/Not Right Away

What type of wholesale partnership are you interested in establishing?

I am interested in purchasing finished Healing Rose products

I am interested in purchasing bulk cannabinoid extracts for processing/manufacturing

I am interested in discussing a private label/white label partnership

How did you hear about the Healing Rose?

Please Upload your State's Tax Exemption Certificate to have Sales Tax Waived. - Our Legal Address for Your Tax Exemption Form: The Healing Rose LLC 23 Hale Street, Unit H Newburyport, MA 01950

PLEASE NOTE: We legally need to have this form to not charge you sales tax. For MA - Please enter your completed and signed ST4 form.

Max. file size: 100 MB.

By providing my email address, I consent to receiving marketing communications, product updates, promotions, and other information from The Healing Rose. I understand that I can unsubscribe from these emails at any time by clicking the “unsubscribe” link in any email or by contacting The Healing Rose directly.(Required)

I agree to receive marketing emails from The Healing Rose.

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Wholesale Intake Form

Wholesale Intake Form

Click here to access your state’s tax exemption form(s)

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