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Resellers & Wholesale

Apply to become a Reseller or Wholesaler with Manifest Health

Application Form

Are you applying to become a Reseller or Wholesaler?
Please select your choice from the drop down:

Title

*Your first Name and Surname (required)

Your Business Name

*Your Address (required)



*Postcode: (Required)

*Description of your Business (required)

*Contact Telephone number (required)

Alternative contact number

*Your Email (required)

Your specialisation

Number of employees

VAT Number

Company Number

*How do you intend to sell the products we supply to you? (required)

Your sales channels:
Own website (if selected please provide the www address below)

Amazon UKAmazon other country (please provide country details below)

eBay UKOther eBay country (please provide country details below)

ClinicShopRetreatDetox ClubOther (please provide details below)

Any further notes/comments

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