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 let us know if you have any questions!

Legal Business Name*
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.
Business Phone Number*
Website
Physical Address*
Street Address Address Line 2 City State ZIP Code
Shipping Address
(If different than above)

Street Address Address Line 2 City State ZIP Code
Billing Address
(If different than above)

Street Address Address Line 2 City State ZIP Code
Main Point of Contact/Buyer*
First Name Last Name Position/Role
Account Email*
Accounts Payable Email (if applicable)
Do you currently carry CBD products?
- Yes
- No
Do you plan to sell our products online?*
- Yes, Right Away
- Maybe/Not Sure/Not Right Away
- No
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.

Wholesale Intake Form

Wholesale Intake Form

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