Become a Reviva Labs Reseller: Join Our Network

Name*

First Last

Email*

Company

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Website*

Tell us about your business

Any DBA’s?*

Yes
No

If you answered "Yes" on DBA's - please list all

Business Focus?*

Type of Business?*

Federal Tax ID*

Input N/A for international

State Incorporated*

Input N/A for international

Sales Tax Exempt*

Yes
No

Sales Tax Cert Upload

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB.

If yes, upload your exemption certificate (10MB Limit)

Business License

Accepted file types: pdf, png, jpg, jpeg, Max. file size: 10 MB.

Please provide a PDF, JPG, or PNG of your business license - max file size 5mb

Credit References

By providing credit reference information, you grant us permission to contact the companies and individuals input regarding your credit & payment history.

Credit 1) Company

Credit 1) Name

First Last

Credit 1) Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit 1) Phone

Credit 1) Email

Credit 1) Average Balance

Credit 2) Company

Credit 2) Name

First Last

Credit 2) Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit 2) Phone

Credit 2) Email

Credit 2) Average Balance

Credit 3) Company

Credit 3) Name

First Last

Credit 3) Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit 3) Phone

Credit 3) Email

Credit 3) Average Balance

Additional Business Information

Do you sell on Amazon?*

Yes
No

List All Amazon, Etc. Seller Name(s)

We are not authorizing new Amazon sellers. You will not be permitted to sell on Amazon.

What channels do you sell through?*

Store Front (Brick & Mortar)
Direct Mail
Own Website
Walmart / Jet
eBay

Facebook URL

Instagram URL

Twitter URL

Pinterest URL

Google+ URL

Linkedin URL

What other skin care brands do you sell?*

How did you hear about us?

Source...*

How should we contact you?*

Telephone
Email

Will you abide by our MAP policy?*

Yes
No

View our map policy here: https://www.revivalabs.com/map-policy/

You agree to our Reseller Terms?*

Yes
No

View our reseller terms here: https://www.revivalabs.com/reseller-terms/

Any Additional Information?

Comments or questions?

Email

This field is for validation purposes and should be left unchanged.

Become A Reseller

Become a Reviva Reseller

Reseller Application

Tell us about your business

Credit References

Additional Business Information

How did you hear about us?

Any Additional Information?

Have An Inquiry About Reviva?

Are You A Reporter With A Press Inquiry?

Need a Skin Care Question Answered?

A Social Media Star Looking To Review Us?

For Any Other Contact Inquiries Or Requests

Subscribe Today

Sign-Up & Save 20% OFF On Your First Order!

Let's Stay Social

Reviva Labs, Inc.

No Parabens, Phthalates, Sulfates, Mineral Oil, Petroleum, or Other Harmful Ingredients - We Promise.