Thank you for your interest in LaBoom® Wholesale Program! Please complete the following application. Your information will be reviewed and responded to as soon as possible. If you have any problems or questions regarding this form or qualification, please email us: wholesale@laboom.life

Business Name (required)

Contact Person Name (required)

Contact Person Title (required)

Contact Person Email (required)

Contact Person Phone

Business Address (required)

City (required)

State/Province/Region (required)

ZIP (required)

Country (required)

What is your Instagram profile name?

How many Instagram followers do you have?

What is your Twitter profile name?

How many Twitter followers do you have?

What is your Facebook page URL?

What is your Website URL?

How will you sell LaBoom™ products? (required)
online
In-Store
Both
Other

How many stores do you have? (required)

How long have you been in business? (required)

Are you currently selling other Self-Tanning products? (required)
Yes
No

If yes, please list:

Briefly Explain Your Business (required)

How did you hear about us?

Your Message

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