Vendor Name *

Business Entity Type *

Address *

Contact Name *

Phone Number *

Address of flagship retail location *

Additional Notes: *

By Applying to be a NEU MIND, LLC Wholesale Customer *

Prepay all invoices promptly.

Not sell on any deal or ecommerce sites not explicitly approved in the agreement (i.e: amazon, ebay, groupon, dealchicken, etc). 

Report any changes of the information being submitted immediately.

You agree to not misrepresent products or brand in any way.
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