WavyWand™ Wavy Wand
WavyWand™ Sales
To receive a dealer information kit, please submit the following form.
Please fill out the form completely.
Items with an "*" are Mandatory.
Please also fax your business or resales license (with tax ID#) to
FAX #: 503-641-4789 - Attention: Sales
Thank You.
Name Information
*Company Name:
*Company dba Name:
Business License information
*Resale License #:
or UBI #:
Business Type (check all that apply):
Retail Store:
Catalog:
Website:
Other:
If "Other" is checked,
describe here:
Business Description:
Target Market
Promotional:
Events:
Specialty Consumer:
Educational:
Other:
If "Other" is checked,
describe here:
Bill To Information
*Address:
*City:
*
State:
*Zip:
Ship To Information
*Address:
*City:
*State:
*Zip:
Contact Information
*First Name:
*Last Name:
*Daytime Phone:
*Email Address:
*Confirm Email:
