Dealer Application

By filing out and submitting this application you are agreeing to our Terms & Conditions

* Required Information

Personal Information
Title	*
First Name	*
Last Name	*
Company	*

Billing Address
Address	*
Address (line 2)
City	*
State	*
Country	*
Zip/Postal code	*

Shipping Address (leave empty if same as billing address)
Address
Address (line 2)
City
State
Country
Zip/Postal code

Contact Information
Phone	*
E-Mail	*
Fax
Web site

Additional information
Sales Tax Number	*
Type of Business	*
Your Position	*

Username & Password [Must contain 6 letters/numbers.]
Username	*
Password	*
Confirm Password	*

Dealer Level [see below]:		Stocking Non Stocking

Stocking Dealer:

A Stocking Dealer is any Authorized Company / Individual who upon reading and agreeing to the Terms and Conditions of Dermacal.com agrees to purchase a minimum of Five Hundred ($500.00) dollars on their initial opening purchase. The stocking dealer will be required to make all shipping arraignments with their Retail customers and collect all monies for the purchase of the products to fill the customers order in a timely manner.

All Retail orders will be shipped no later than the following business day after the receipt of the customers order. In the event a Order shall be shipped from the Manufacturer a drop shipping charge of $ 2.00 per order shall apply.

Product inserts will be enclosed with each order. Only approved Product inserts shall be included with all shipments. Printed materials will be supplied to the dealer at no cost with the first order placed. Approved 3-part fold-over Brochures can be purchased from the manufacturer at a cost of .15 each.

Non Stocking Dealer:

A Non Stocking Dealer is any Authorized Company / Individual who upon reading and agreeing to the Terms and Conditions of Dermacal.com and paying the Dealership fee equal to the sum of $250.00 will become a Non-Stocking Dealer.

All Retail orders will be shipped no later than the following business day after the receipt of the customers order, directly from the manufacturer. The Non-Stocking Dealer will be responsible for the collection of all monies from their retail customer, including a $2.00 per order dropship fee, and all shipping charges.