Pure Botanics

Pure Botanics Wholesale Account Application

If you are a business owner in the healthcare field or a related field, you can qualify for our wholesale rates. Simply fill out the online application or download the application and send it by facsimile to 1 (505) 843 7027. We will then e-mail, fax, or mail your wholesale pricelist. Please note that we require a copy of your business license before we can approve your wholesale account. The information you provide is strictly confidential. We will never sell, give or transfer the following information to any third party.
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Your Name:

Name of your business:

Type of Business:

Street Address:

City:

State:

Zip Code:

Phone number:

Fax number:

Email:

Please indicate your intended use of our products:
As part of a treatment regime; As part of a retail business

Please let us know about your license and schooling, if any (not required).
Professional degree held:
School attended:
Year graduated:

Please indicate how you would like to receive your wholesale price list, if approved:
email; fax

You must fax a copy of your professional or business license to 1(505) 843-7027, or by e-mail to info@purebotanics.com, for your application to be complete.