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Distributor Application
Thank you for your interest in becoming a Distributor of our products! When you've finished filling out this form, press "Submit" and your application will be sent to us for review. Please be sure to include your email address and a phone number so that we can contact you! Fields marked with a * are required.

If you're also interested in experiencing a hands-on review our products, we strongly suggest you order a Distributor Starter Kit. Click here for more information.

  Company Information
*Email:
*First Name:
*Last Name:
Company Name:
*Address:
*City/State/Postal:
*Country:
*Address Location:
*Type of Company:
Chiropractor
Massage Therapist
Gift Shop
Gym/Fitness Center
Mall Cart
Fairs & Festivals
Beauticontrol
Home Party Prgm
Doula
Pharmacy
Online Retailing
Catalog
Hair Salon
Nail Salon
Spa
Other
*Day Phone:
Cell Phone:
Corporate Tax ID: (or SSN)
Website URL:
How did you hear about us?
Nukkles Package
Trade Show
Word of Mouth
Referred by:
Web Search
Advertisement
Other
  Business Plan
*Products you are interested in distributing:
Nukkles products
Tingler products
Botanical Fresh products
Quiklets
MicroSmores
*How long have you been in business?
*Realistically, how many Nukkles, Tinglers, Botanical Fresh and/or Quiklet units do you expect to sell per month?
*How will you sell our products? 
(e.g. mall cart, store, salon, etc.)

Thanks for submitting your distributor application with BodyTime wellness. Once it has been received, one of our staff will be in touch with you discuss this opportunity and also to go over wholesale pricing with you. We look forward to talking with you soon!

                      

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Nukkles
PO Box 9 • Chester, NJ 07930
866-826-3984 • 908-879-7762 • fax 908-879-5717 • email