Wholesale Registration

Thank you for your interest in becoming a wholesale customer of Nopal Juice. To help us serve you faster and better please fill the wholeslae inquiry form as complete as possible.
Customer information will not be shared or distributed, it is only used solely for business purpose with Desert Bloom Online Dpt. We ask for complete information so we can expedite the application and approval of your wholesale account. A copy of your company sales tax certificate or EIN certificate must be faxed to our toll-free fax #866-998-9929 to process your application. Applications received without a copy of your company's certificate will be held until we receive all required information. Upon approval we will send a unique user name and password so you can view pricing and place orders on our website. If you have questions while completing this form, please contact us.

Wholesale Registration Form

All fields marked with * are required.


Retailer, Chiropractor, Herbalist, Medical Doctor, ...

or, your EIN certificate is required.
If you don't have one yet, please explain.
What is your short term, mid term, and long term sales projection in the amount of bottles per month?

 
For Spam prevention purpose- Please enter the result.








Get NO Payment & NO Interest for 6 month when you pay with Bill Me Later®, a PayPal service.
Just select Bill Me Later as your payment choice during checkout. Just look for it below PayPal on the Choose Payment Method page. You'll give your Date of Birth and the last 4 digits of your Social Security number, accept the terms, and you're done. Approval takes only seconds. No PayPal account required.