Become a Retailer or Distributor

Your Name (required)

Your Email (required)

Phone Number

Company/Business Name

Website

Full Address/Location of Business

Type of Business

FEIN Number

Business Tax ID

How long have you been using Shanti Kai Essences?

Are you a Licensed Practioner? YesNo
If Yes, what is your modality?

Do you have or are you representing a store? YesNo
If Yes, what is the name of the store (if different than Business name above)?
If No, where will you be selling Shanti Kai Essences? (Note online stores are not eligible)

Will you have a display of Shanti Kai Essences? YesNo

How will you be selling/using Shanti Kai Essences?

Will you be advertising Shanti Kai Essences on your social media? YesNo

If yes, please list your applicable social media accounts below:

How did you hear about us?

If you are interested in a particular Essence Line(s) please list them below.

Additional Comments

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