New Customer Application

Please complete our wholesale application below. Within 24-48 hours we will reach out by phone to introduce ourselves and provide product information. We will also send you login credentials, so you can begin ordering. We appreciate the support!

Company Info

Business Name *

FEIN (Fed Tax ID #) *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Business Email *

Website

Personal Info

Name *

First

Last

Email *

Phone *

Shipping Info

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Upload Documents

FEIN (Federal Tax ID #) *

Click or drag a file to this area to upload.

Business License or Sellers Permit

Click or drag a file to this area to upload.

Live Rite Mission

To improve the health and well being of our community, by connecting them to clear information & the very best products.

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