For Wholesalers

If you are a wholesaler interested in carrying our products – great! Please complete the following information, and someone will contact you shortly![/vc_column_text][vc_empty_space height=”30px”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Business Name
First Name (required)
Last Name (required)
Phone Number (required)
Email Address (required)
EIN Tax ID Number
Business Type (required)Single locationMultiple locationsDistributor
Industry (required)Smokeshop/VapeshopHealth Food StoreHealthcare ProviderChiropractorAcupuncturistFitness CenterWellness CenterOther
Address (required)
Products of InterestVaporizers/OilSublingual DropsTopicalsGumPet Products
Do you currently purchase Rx Remedies Inc. products? (required)Yes (directly)Yes (via distributor)No
*If yes, from who?
How did you hear about Rx Remedies Inc.?Google searchFriendSocial mediaAdvertisementOther