Mama Gaia’s Zen Garden Wholesale Application Form Business Information: Business Name: Contact Person (First and Last Name * First Name Last Name Email Address * Phone (###) ### #### Website http:// Business Address Address 1 Address 2 City State/Province Zip/Postal Code Country Tax Information: Business Tax ID Number Resale Certificate Number (if applicable) Do you have a physical storefront, online shop, or both? Order Details: Products Interested In (Check all that apply): Herbal Teas Tinctures Flower Essences Other Wellness Products Expected Order Volume: $200-$500 $500-$1,000 $1,000+ Custom Orders or Blends Needed? (Yes/No) Yes No Shipping Preferences: Preferred Shipping Method: Standard Expedited International (Outside of U.S.) Local Delivery (Within 60 Miles of Umpire, AR) Do you need delivery on specific dates or timelines? Yes No If Yes, please specify the timeline: Payment Preferences: Preferred Payment Method: Credit Card Paypal Bank Transfer Cash/Check on Delivery Net 30 Terms (For approved clients only) Additional Information: Any Additional Notes or Requests? Acknowledgments: I acknowledge the minimum order requirement of $200 for wholesale purchases. * Yes I agree to Mama Gaia’s Zen Garden wholesale terms and conditions. * Yes Signature * Date * MM DD YYYY Thank you! We will review your application and contact you within 2 business days. If you have an urgent request, please contact us at support@mamagaiaszengarden.com.