Wholesale Ordering Username & Password Request Form

Access to Somersault Life Co. Wholesale Product/Pricing Information and online ordering requires a wholesale username and password. If you do not have a wholesale username and password, please complete the online request form below and we will be happy to provide one to you.

Upon completion and submission of your request, we will confirm your request and provide to you a username and password within 2 business days.

Please Complete the Form Below

* - Required Information
Business Name:*
Reseller's Permit #:* (Issued to you by the State)
(Also known as: Sales Tax Exemption # or Wholesale License #)

Primary Contact - First Name:*
Primary Contact - Last Name:*
Business Address 1:*
Business Address 2:
City:*
State:*
Zip Code:*
Phone Number:*
Fax Number:
E-mail Address:*
Do you currently sell Somersault Life Co. products?
How did you find out about Somersault Life Co.?
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