Account Application

If you haven't previously shopped with us please complete this new account application form.

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Salon Professional Information

• Salon Name
• First Name
• Last Name
• License / Student ID
• License State (State/Province) Alabama Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• License Expiration Date

• Type Code (Select) Beauty Supply Full Service Spa (has skin) Full Service Spa (no skin) School (choose for students also) Medical Only Nail Only Personal Skin Center Only Hair Only Wax Only
• Class Code (Select) Booth Renter Lease/Commission - Owner Commission Student School Personal Shopper
• Brands interested in: All-Nutrient Babe BlueCo Brands bōkka BOTÁNIKA Cezanne Comfort Zone Cricket CRYBABY WAX Davines DEPOT® Diane Ecoheads epres evo FASTFOILS Framar Fromm Fuji gama.professional Gamma+ Highland HOT LIKE ME Intrinsics Jatai KASHO Keracolor L'ANZA LOMA made milk_shake Nufree Nudesse O2 Olivia Garden Paper Not Foil Perfectress Product Club QualityTouch Re:BOND RefectoCil Saints & Sinners Salon Chair Guys Salonchic Scalpmaster Scrummi Solano Style Edit StyleCraft Sunlights Surface Hair Valera VoCê Wet Brush William Marvy Company Zotos

• Your Main Color Brand
• Your Main Retail Brand

• How did you find us?
• Potential Yearly Purchase

Account Information

• Business Development Manager (Select) I do not have one yet Kevin Anderson Kim Attoe-Simon Charles Balzum Heather Bauer Remy Beauclaire Elliot Beckstrom Terri Bryce Garette Coleman Kim Colton Leslie Eckert Joe Haupert Jody Johnson Katherine La Fave Gerilynn Pate Lisa Rafert Judi Wiese
• Resale Tax Number (Optional)

Contact Information

• First Name
• Last Name
• Job Title

• Email Address
• Phone

• Please provide the best number you can be reached at during normal business hours Monday - Friday.

Billing Information

• Address
• City (State/Province) Colorado Iowa Minnesota Nebraska North Dakota South Dakota Wisconsin Wyoming
• Postal Code

Shipping Information

• Address
• City (State/Province) Colorado Iowa Minnesota Nebraska North Dakota South Dakota Wisconsin Wyoming
• Postal Code

We are committed to fighting the unauthorized sale of professional product at non-salon retailers.

Please provide your consent to abide by our diversion policy.

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