For consideration to re-sell or distribute our Magceutics branded products please complete the application form below.

First Name *

Last Name *

Company Name *

Company Address *

City *

State *

Zip Code *

Country *

Phone *

Email *

Website *

Do you currently sell Nutritional Supplements? *

Answering 'NO' will not automatically remove your application from consideration

Where are you currently selling products *

Check all that apply

Where will you sell our products?: *

Check all that apply

Annual Revenue *

What is your current revenue selling similar products in this area?

Estimated Revenue *

Please estimate your selling volume of our products annually. (Your discount will be determined from your buying volume)

Additional Information

Please include any additional information that may help us in reviewing your application.

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!