New Distributor Information Form

I am actively seeking qualified distributors in a number of countries worldwide to begin distributing Acne.org products. Please take a moment to fill out the form below so we can ensure a successful partnership. At Acne.org, we strive to give you the best products at the best prices so you can help get the Acne.org Regimen out to as many people in need in your locale.

Once you have submitted your New Distributor Information Form listed below, an Acne.org representative will contact you concerning the wholesale program available (pending approval). We look forward to working with you and building your business.

Kind Regards,

Dan Acne.org products

Some fields were not entered correctly. Please correct them and resubmit the form.

    Distributor name
    Contact name
    Contact email
    Distributor address

    Distributor city
    Distributor state/province
    Distributor postal code
    Distributor country
    Phone
    Fax
    Mailing address
    (if different from above)


    Mailing city
    Mailing state/province
    Mailing postal code
    Mailing country

    Please list retailers that you currently distribute to along with their type (e.g. pharmacy, health food store, beauty, etc.).

    Please list specific skin care lines that you currently carry:

    How many representatives distributor your lines?

    How long have you been a distributor?

    Can you provide Acne.org with sell-thru data?

    Yes No (explain why)

    How do you plan on marketing Acne.org in your area?

    Do you have a website? If so, please provide the URL.

    Please include any additional information you would like us to know.

    * required fields

    If you have any questions, please call us at 1-800-773-7803, 9 AM - 5 PM pacific time.