Wholesale Sample Request Form

Legal Name of Company*
DBA (if applicable)
Federal Tax ID*
Number of Locations
Website (if not applicable, please enter n/a)*
Business Category*
- Retail store
- Dental office
- Healthcare office (MD, ND, DC, LaC, LMT, etc.)
- Online store
- Buyer's club
How did you hear about OraWellness? (Who referred you?)*
Company Primary Contact Info
First Name*
Last Name*
Email Address*
Phone Number*
Company Address*
Street Address City State / Province / Region ZIP / Postal Code Country
What kind of HealThy Mouth Bend would you like?*
What kind of Shine would you like?*
What kind of Bass toothbrush would you like?*
Newsletter

By submitting this wholesale sample request, you agree to be added to the OraWellness wholesale emailing list. Rest assured, we fiercely defend your privacy, and we will never sell your information to any third party. Also, you can unsubscribe at any time by clicking the 'Unsubscribe' button in the bottom of one of our automated emails or by sending your unsubscribe request to [email protected].
Agreement*
I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the eligibility for a wholesale sample or wholesale account for above stated company with OraWellness LLC. Furthermore, if I begin selling OraWellness products, I agree to the OraWellness General Wholesale Policy. And if selling online, I also agree to the OraWellness Minimum Advertised Price (MAP) Policy. I also understand that OraWellness prohibits the sale of their products on third party platforms like Amazon or eBay. Details of the OraWellness General Wholesale and OraWellness MAP policies can be found at https://orawellnesswholesale.com/pages/policies. *
CAPTCHA

Company Primary Contact Info

Newsletter