Pura Wholesale Inquiry Form

Please complete this form if you are interested in becoming a Pura wholesale/resell customer

Full Legal Business Name*

DBA Company Name*

DBA Name (If this is the same as your Legal Business name, please copy here)

Main Contact - First Name*

Main Contact - Last Name*

Main Contact - Email*

Phone Number*

Billing Address:

Street Address*

City*

State/Region*

Postal code*

Shipping Address:

Physical - Street Address*

Physical - City*

Physical - State/Region*

Physical - Postal Code*

Country/Region*

Website URL*

If you do not have a website enter N/A

Brick & Mortar Locations*

How many brick & mortar locations do you have?

Company Type*

Check which type of company is applicable to you

Company Industry*

Federal ID#:*

If you do not have one, please type 0

Business License*

Upload a copy or photo of your current business license or resale tax id

Dun & Bradstreet Reference #:*

If you do not have one, please type 0

Who are your customers?*

(Check all that apply)

End Consumer

Retailers

Distributors

Other

Who do you consider your market to be*

Describe your key customer profile

Company Description*

Tell us a little about your company and how Pura fits in

Please identify all source(s) of Pura products you are selling or intend to sell*

Intend to purchase directly from Pura Scents

Purchase from Distributor(s) (list below)

Other (describe below)

List Distributor(s) or Other

Complete if you selected: purchase from a distributor or other

Review our full Authorized Retailer Policy - here

You acknowledge that authorization to sell Pura products is only granted after Pura has approved of Applicant to be an Authorized Retailer, as applicable to Applicant and that submission of this Application does not confer “Authorized” status to the Applicant. You acknowledge that if you are approved by Pura to be an Authorized Retailer, you will be subject to the Pura Scents Authorized Retailer Policy for the United States. If you are approved to be an Authorized Retailer by Pura, please note that you are permitted to sell on your own proprietary website, but the Authorized Retailer Policy prohibits you from selling Pura products on online marketplaces (such as Amazon, eBay, and Walmart Marketplace) without Pura’s prior written consent.*