Broker/Distribubor Application
[Body Balance System Ionic FootBath Units & other products]

We are committed to supplying the best products available. We invite you to take this opportunity to apply for membership as an Authorized Distributor or Partner For Health. We strive to review every application in a timely manner.
Once you have completed this application simply ckick on SUBMIT. We shall contact you very shortly. Thank you!


         
 
Your Company Name:
    
 
Name of owner(s)
    
 
Contact First Name
    
 
Contact Last Name
    
 
Address
    
 
Address line 2
    
 
City
  
State
Zip
 
 
Phone Number
    
 
Web Site Address
    
 
E-mail Address
    
 
Number of years in business
    
 
Do you mainly sell via a storefront or online
      Yes or No or % of sales sold online  
 
Type of items sold in store
    
 
Other brands sold
    
 
Number of FootBath units you anticipate selling per month
    
 
Will you need drop shipping or will you stock the units?
   Drop shipping or Stock or Both  
 
Additional information