Wholesale Application - Dr. O'Connor

Contact Information

First Name:

Last Name:

Business legal name:

Email:

Business License #:

Sales Tax #:

Business Address

Street address:

2nd line for Street address:

Country/Region:

City:

State/Region:

Postal code/Zip Code:

Business phone number:

Tell us about you

What is your profession?

Please check the social media accounts that may apply:

Please share social media handles with us

Website URL

Where do you intend to resell our products?

How did you hear about us?

Which product(s) are you inquiring about?

Please upload a copy of your business license, reseller license, and sales tax license

Dr. O’Connor – The Trusted Doc is committed to protecting and respecting your privacy. We will only use your personal information to process your orders, manage your account, and provide the products and services you request from us. From time to time, we may also contact you about our products, services, and other information that may be of interest to you. If you agree to be contacted for these purposes, please indicate your consent below.

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I confirm that all the information provided is accurate and valid.

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By clicking “Submit” below, you consent to Dr. O’Connor – The Trusted Doc storing and processing the personal information provided above in order to fulfill your request.