WHOLESALE SAMPLE KIT REQUEST FORM

Thank you for your interest in THARA SACRA products.

To order your sample kit please complete the following application. If you have any problems or questions regarding this form, please send an email to hello@tharasacra.com.

Business Name

Website

http://

A THARA SACRA REPRESENTATIVE WILL USE DATA PROVIDED TO MANAGE DELIVERY OF THE SAMPLE KIT AS WELL AS FOLLOW UP COMMUNICATIONS REGARDING A POTENTIAL WHOLESALE RELATIONSHIP. PLEASE CHECK BOX IF YOU WOULD ALSO LIKE TO ALSO LIKE TO BE ADDED TO OUR WHOLESALER EMAIL LIST TO RECIEVE ADDITIONAL OFFERS, INFORMATION ON NEW PRODUCTS AND MORE. YOU CAN OPT OUT AT ANY TIME BY CONTACTING HELLO@THARASACRA.COM.

YES

Contact Person's Name

First Name

Last Name

Contact Person's Email Address

Business Address

THIS WILL BE THE ADDRESS THE SAMPLE KIT IS SHIPPED TO

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Professional / Business License Number

What is your primary business type?

List any additional locations

How many years have you been in business?

What products/brands do you use or carry?

What product do you wish you had?

Example: I wish I had a balm for massage that easily glides on skin

How did you hear about THARA SACRA?

Additional comments

WHOLESALE SAMPLE KIT REQUEST FORM

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