Become a Reseller

Thank you for your interest in becoming a Vibrant Health Reseller. To help us initiate the account set up process, please complete this form and fax a copy of your business license to 203-922-0473. A representative will follow up with you by phone within 2 business days of the receipt of application.

If you have any questions, please call us at 800-242-1835.

Our Product Purchase Guarantee

We hope you love our products. If you or your customers are dissatisfied with any product purchased from Vibrant Health, simply call our toll free number, 1-800-242-1835 within 90 days.

Retailer Type*
Store / Business Name*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Information
Contact Name*
First Last
Email*
Phone*
Company Information
Resale Certificate*
Please scan and attach your Resale Certificate. Alternatively, you can fax this document to 203-922-0473.
Federal Tax ID / EIN #*
Practitioner Related License(s) / Certificate(s) – If applicable*
Please scan and attach your Practitioner Related License(s) / Certificate(s). Alternatively, you can fax this document to 203-922-0473.
*If you are having issues submitting documentation, please call our customer service team at 1-800-242-1835.
How long has your company been in business?*
What are the primary products/services your company offers?*
Does your company have a website on which our products will be sold?*
Please provide website address.*
Do you carry any other dietary supplements?*
Are you a current partner with INFRA or NCG?*
- INFRA
- NCG
- N/A
Please name a few dietary supplements you carry.*
How did you hear about us?*
Any questions or comments?
Signature
By signing below I acknowledge the above is true and correct. I understand that completion of this form does not guarantee a Vibrant Health Reseller Account. I understand that failure to abide by all Vibrant Health policies, terms and conditions, including the Online Sales Policy, will result in termination of the relationship.
*
- I agree to these terms
Signature (please type your name)*

Become a Reseller

Contact Information

Company Information

Signature

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