Apply for access · Valley Wellness Group

Apply for wholesale access

Complete the form below and our team will be in touch within one business day.

Contact Information

First Name *

Last Name *

Suffix

Email *

Phone *

Business Profile

Business Name *

Business Type *

Website *

Tax ID / EIN *

NPI Number *

Does your business have a reseller’s license *

YesNoNot Sure

Helps determine your eligibility for sales tax exemption.

Reseller’s Permit Number *

Upload Reseller’s Certificate

PDF, DOC/DOCX, XLS/XLSX/CSV, JPG/JPEG, PNG, GIF · up to 15 MB

Business Address

If not applicable, use your main operating address.

Street Address *

City *

State *

Country *

Postal code *

Verification & Referral

Upload Proof of Business or Professional License

Optional at this stage. Clinics may upload a business permit; individual providers may upload a license or valid ID. Required later to complete your application.

PDF, DOC/DOCX, XLS/XLSX/CSV, JPG/JPEG, PNG, GIF · up to 15 MB

Referred by someone? Let us know!

Optional—but filling this in may give you priority approval if applicable!

Additional Notes

Comments