Wholesaler Registration

Please download and fill out the following forms to be submitted with your wholesaler application form.

Documents must be completed, signed and emailed to service@thevitaminpatch.com before wholesale access will be approved.

Personal Details

First Name^*

Last Name^*

Additional Information

Conpany Name (if any)

Street^*

City^*

State^*

Zip^*

Country^*

Phone Number^*

Account Information

User Name^*

Email^*

Password^*

Confirm Password^*