New Retailer Information Form

I am actively seeking qualified retailers to sell Acne.org products in your stores. 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 community.

Once you have submitted your New Retailer 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.

    Store name
    Contact name
    Contact email
    Store address

    City
    State
    Zip
    Phone
    Fax
    Mailing address
    (if different
    from above)

    City
    State
    Zip

    In which type of shopping areas are you located?

    Freestanding Mall    Other

    Do you have more than one location?

    Yes No

    If yes, please list all locations:

    Please list any chain or independent beauty retailers, pharmacies, or health food stores near you:

    Please describe your store - check all that apply:

    Beauty Supply
    Pharmacy
    Spa
    		 Hotel Retail Shop
    Hair Salon
    Beauty Boutique
    		 Vitamin Store
    Health Food Store

    Other

    Store square footage:

    What do you predominantly sell (i.e. health products, beauty products, vitamins)?

    Please describe your typical customer (age range, etc.):

    Please list other skin care lines that you currently carry:

    Where would you display Acne.org products in your store?

    Why do your customers shop at your store?

    How do you market to your customers (i.e. mailings, loyalty programs, in-store events)?

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

    Yes No (explain why)

    Has your store received any press or community recognition? If so, please describe.

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

    Please attach any photos of your store, if possible.



    * required fields

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