Dealer Application Form

Thank you for your interest in becoming a distributor for Venus Naturals. To apply for dealer status or to become a distributor for our product line, please fill in the form below and click the 'send' button. We will contact you by e-mail/fax with our wholesale price list.


  Name           
  Position       
  E-mail         
  Company        
  Address        
  City           
  State/Province 
  Country        
  Web Address    
  Telephone        Fax 


  Check the products that you are interested in:

      Venus Creme             Seaweed Shower Gel
      Venus Capsules          Fruit Acid Cream
      Stretchmark Cream       Venus Eye Creams
      Libido-Lift             Invisi-Vein, leg lotion
      Firming Lotion          Daily Skin Care
      Firm Contours           Acne Treatment Products
      Oxy-Trim                Cellagen
      Pycnogenol Cream (NEW)  Pain-Eez (NEW)
      Whitening Cream (NEW)


  Aproximately what monthly volume
  would you be purchasing?

      less than 50 units     50 - 100 units
      100 - 500 units        500 - 1000 units
      1000 - 2000 units      more than 2000 units

  How do you plan to sell our products?
  (check all that apply)

      mail order (magazine ads etc.)
      web site online
      stores (drug stores, health stores etc.)

  How do you currently distribute your products?

     

  Are you looking for an exclusive (for your territory, country)?

      yes    no

  Comments:

     

  Enter Security Code:

        
  

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