contact us: professional contact information

We are excited and enthusiastic about the number and quality of estheticians that have ordered and re-ordered our products. We believe in maintaining quality service by using trustworthy and dedicated estheticians who uphold the highest standards for the end customer.

If you would like to join us as a professional, please complete the information below and submit it to us. We will respond to you via email with our decision. If approved, you will receive a user name and password so you may begin ordering our products online.

Step 1 - Complete the form below

Step 2 - For Missouri Resellers, please click here to download the Certificate of Resale Form (MO 860-1528). Once completed and signed, fax or mail it to us:

Corporate Offices: 417-724-9302

Or mail it to: 1260 West Guin Road, Nixa, MO 65714

Do not hesitate to call us toll free at 1-877-754-6253 (spells 1-UPS-SKINBLENDS) with any questions.

Skincerely,

Skin Blends Award Winning Customer Service Team

Fields with an asterisk(*) are required.

*First Name:

*Last Name:

*Email:

Birth Month:
(So we can remember you in a special way)

Have you ever ordered from SkinBlends before?

Yes No

*Position:

Owner	Esthetician	Cosmetologist
Student

*Esthetician/Cosmetologist
License #:

Business Name:

*Shipping Address (no P.O. Box):

Business Residence

*City:

*State:

*Zip:

*Main Contact Phone:

xxx-xxx-xxxx
Business Cell Home

Alternate Contact Phone:

xxx-xxx-xxxx
Business Cell Home

Fax Number:

xxx-xxx-xxxx

Business Website:

*Type of Skin Care Business:

Independent Clinic	Medical Facility	Day Spa
Destination Spa	Salon	Other

*What year was business established:

Name of Medical Director
(if applicable):

Name of Business Owner
(if other than yourself):

Number of Employees:

Number of Estheticians:

Number of Treatment Rooms:

Which services do you currently
offer or plan to offer in the future?

Service	Yes	No	Planned
Spa Facials
Corrective Facial Treatments
Waxing
Microdermabrasion
Manual Microdermabrasion
Peels
LED Light Therapy
Makeup
Capillary and Skin Tag Removal
Ultrasound and Electrical Stimulation
Retail
Custom Blended Retail
Other

What skin care lines do you currently use?

*How did you hear about Skin Blends? Please list the name of the trade journal, trade show, or person who referred you to us.

Insurance Provider for Your Professional Liability Insurance

Name of Provider:
Policy Number:
Expiration Date:

Other Comments:

* By clicking this box, I agree to only sell Skin Blends products at the Suggested Retail Prices
(although I may have periodic specials, promotions, etc.)


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