Wholesale Application Form Step 1 of 4 25% Interested in becoming a wholesaler with us? Fill out our quick application form to access exclusive benefits, streamlined ordering, and dedicated support tailored to your business needs. Join our network today and unlock a world of opportunities in wholesale partnership!Are you located in the United States?(Required) Yes (USA Based) No Tell Us About Your BusinessBusiness Name(Required)Business Location(Required)-- Select Business Location --HomeCommercial BuildingBusiness Legal Struture(Required)-- Select Business Legal Structure --Sole ProprietorPartnershipC-CorpS-CorpOwner/Practitioner First Name(Required)Owner/Practitioner Last Name(Required)Website(Required)FacebookInstagramLinkedInHow Do You Educate Patients/Clients? Website Podcast In House Educator Newsletter Text Podcast HandleBusiness Information and ContactEIN(Required)Or Social Security Number,if you don't have an EINDo you Stock Supplements or Products?(Required) Yes No Business Phone(Required)No hyphens, spaces, or parenthesis.*No letters, hyphens, spaces, or parenthesis in the phone number field.This field is hidden when viewing the formBusiness Phone Output to CRMBusiness FaxEmail(Required)This email address will be associated with your Wholesaler account and be used as part of your login credentials How did you hear about us?(Required)--- Please select ---FacebookInstagramYoutubeLecturePodcastEventsOtherIf Podcast or Event please share who/where:(Required)Delivery Street Address 1(Required)Delivery City(Required)Delivery State(Required)Delivery Postal Code(Required)Delivery Country(Required)Please select oneUnited StatesCanadaAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas (the)BahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean Territory (the)Brunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCayman Islands (the)Central African Republic (the)ChadChileChinaChristmas IslandCocos (Keeling) Islands (the)ColombiaComoros (the)Congo (the Democratic Republic of the)Congo (the)Cook Islands (the)Costa RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech Republic (the)DenmarkDjiboutiDominicaDominican Republic (the)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (the) [Malvinas]Faroe Islands (the)FijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern Territories (the)GabonGambia (the)GeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (the)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea (the Democratic People's Republic of)Korea (the Republic of)KuwaitKyrgyzstanLao People's Democratic Republic (the)LatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia (the former Yugoslav Republic of)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall Islands (the)MartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Midway IslandsMoldova (the Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlands (the)New CaledoniaNew ZealandNicaraguaNiger (the)NigeriaNiueNorfolk IslandNorthern Mariana Islands (the)NorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippines (the)PitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian Federation (the)RwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSouthern RhodesiaSpainSri LankaSudan (the)SurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan (Province of China)TajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos Islands (the)TuvaluUgandaUkraineUnited Arab Emirates (the)United KingdomUnited States Minor Outlying Islands (the)Upper VoltaUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweBusiness AddressBusiness Street Address 1(Required)Business City(Required)Business State(Required)Business Postal Code(Required)Business Country(Required)Delivery CountryUnited StatesCanadaAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas (the)BahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean Territory (the)Brunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCayman Islands (the)Central African Republic (the)ChadChileChinaChristmas IslandCocos (Keeling) Islands (the)ColombiaComoros (the)Congo (the Democratic Republic of the)Congo (the)Cook Islands (the)Costa RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech Republic (the)DenmarkDjiboutiDominicaDominican Republic (the)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (the) [Malvinas]Faroe Islands (the)FijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern Territories (the)GabonGambia (the)GeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (the)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea (the Democratic People's Republic of)Korea (the Republic of)KuwaitKyrgyzstanLao People's Democratic Republic (the)LatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacaoMacedonia (the former Yugoslav Republic of)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall Islands (the)MartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Midway IslandsMoldova (the Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlands (the)New CaledoniaNew ZealandNicaraguaNiger (the)NigeriaNiueNorfolk IslandNorthern Mariana Islands (the)NorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippines (the)PitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian Federation (the)RwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSouthern RhodesiaSpainSri LankaSudan (the)SurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan (Province of China)TajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos Islands (the)TuvaluUgandaUkraineUnited Arab Emirates (the)United KingdomUnited States Minor Outlying Islands (the)Upper VoltaUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweFinish ApplicationRESELLER AGREEMENT: By checking the box below, I agree to sell or provide Pneuma Nitric Oxide products to end users, and Professional will not supply Pneuma Nitric Oxide products to unauthorized re-sellers or retailers. Pneuma Nitric Oxide LLC Internet Reseller Policy prohibits the sale of its products on third party facilitated sites (e.g. Amazon, eBay, etc.). By placing an order with this form, you are verifying that you have read and agree to Pneuma Nitric Oxide LLC Internet Reseller Policy.I understand and accept the Wholesaler/Reseller Agreement(Required) I agree By checking the box below, I certify that all the information on this form is correct.(Required) I agree N1O1 Minimum Advertised Pricing Policy (MAP) Thank you! Next please sign your MAPS agreement. N1o1 Minimum Advertised Pricing Policy (MAP) Effective September 1, 2021, a Minimum Advertised Price (MAP) on all N1o1 Pneuma Nitric Oxide LLC products will be in effect. This policy is strictly policed to prevent abuse. N1o1 Pneuma Nitric Oxide LLC has built a brand of high perceived value. By not adhering to the established Minimum Advertised Price (MAP) policy, a reseller can cause the dramatic effect of diminishing or detracting from that value and brand. Furthermore, this MAP policy has been established by PC to help protect its dealers and the reputation of its products. The MAP policy is designed to ensure authorized dealers and resellers who buy from authorized dealers add value to N1o1 Pneuma Nitric Oxide LLC products and do not unfairly limit legitimate retail competition. Therefore, any reseller of products manufactured and or distributed by N1o1 Pneuma Nitric Oxide LLC. must abide by the following requirements and restrictions. The MAP policy guidelines: The Minimum Advertised Price for any N1o1 Pneuma Nitric Oxide LLC product under this MAP policy shall be determined on a SKU level. MAP pricing is established by N1o1 Pneuma Nitric Oxide LLC and may be adjusted by N1o1 Pneuma Nitric Oxide LLC at its sole discretion. The MAP policy applies to any and all advertised price of N1o1 Pneuma Nitric Oxide LLC products. The MAP policy is not applicable to any in-store advertisement not Distributed to any customer(s) outside of their store or any N1o1 Pneuma Nitric Oxide LLC authorized discount offer. The inclusion in advertising of a bundle, free or discounted products (whether made by N1o1 Pneuma Nitric Oxide LLC or another manufacturer) Page 1 of 3 including a product covered by the MAP policy would be contrary to the policy, if it has the effect of discounting the advertised price of the covered product below the MAP. If pricing is displayed in other than a brick-and-mortar retail store, any strikethrough or other alteration of the Minimum Advertised Price is prohibited. However, the discounted price can be shown in the website cart. MAP applies only to advertised prices and does not apply to the price at which the products are sold. N1o1 Pneuma Nitric Oxide LLC authorized dealers and resellers remain free to sell these products at any price they choose, as long as, the advertised price remains at or above MAP. MAP does not establish maximum advertised prices. All dealers and sales representatives may offer N1o1 Pneuma Nitric Oxide LLC products at any price, in excess of the MAP. N1o1 Pneuma Nitric Oxide LLC MAP policy does not in any way limit the ability of any authorized dealer to advertise that they "have the lowest prices” or, they "will meet or beat any competitors price”, that consumers should "call for pricing” or phrases of similar import as long as the price advertised for the products is not less than MAP. Dealer agrees to hold all trademarks and copyrights of N1o1 Pneuma Nitric Oxide LLC. as the property of N1o1 Pneuma Nitric Oxide LLC. Use advertising materials provided by N1o1 Pneuma Nitric Oxide LLC. in an authorized manner only. N1o1 Pneuma Nitric Oxide LLC does not intend to do business with any entity who degrades the image of N1o1 Pneuma Nitric Oxide LLC and its products. It is at N1o1 Pneuma Nitric Oxide LLC sole discretion whether or not to provide prior notice or issue warnings before taking any action under this policy. N1o1 Pneuma Nitric Oxide LLC prohibits targeting or use in any SEO capacity: the N1o1 Pneuma Nitric Oxide LLC company name, product names, or key terms that are specific to our brand and all N1o1 Pneuma Nitric Oxide LLC owned products. Wholesalers and distributors shall not sell, resell, list, advertise, or otherwise offer for sale any Pneuma Nitric Oxide LLC products on Amazon, Walmart.com, eBay, Google, Meta, TikTok or any other online marketplace or third-party sales platform. This prohibition includes direct listings, sales made through third-party entities, and any indirect method intended to circumvent this restriction. For avoidance of doubt, “indirect listings” shall not include participation in any official affiliate program or authorized sales initiative expressly established in writing by Pneuma Nitric Oxide LLC. Any violation of this provision shall constitute a material breach of this Agreement, and the violating party shall be subject to immediate termination of its wholesale or distributor rights, without limitation of other remedies available to Pneuma Nitric Oxide LLC at law or in equity. Pricing Disclaimer: Pneuma Nitric Oxide LLC maintains authorized listings for its products on Amazon and other marketplaces. Pneuma Nitric Oxide LLC shall have the exclusive right, at its sole discretion, to establish, adjust, and modify pricing on such platforms, including, without limitation, setting prices below any published Minimum Advertised Price (“MAP”). Such adjustments may occur in response to unauthorized third-party sellers, special promotional events (including but not limited to Prime Day, Lightning Deals, and holiday promotions), or for any other business purpose deemed necessary by Pneuma Nitric Oxide LLC. By entering into this wholesale or distributor relationship, the undersigned acknowledges and agrees to the foregoing and further acknowledges that Pneuma Nitric Oxide LLC retains all rights with respect to the pricing and positioning of its products in any online or offline marketplace. It is the responsibility of the authorized dealer to ensure compliance of its customers to N1o1 Pneuma Nitric Oxide LLC MAP policy. Authorized dealers who provide N1o1 Pneuma Nitric Oxide LLC products to third party resellers may have their dealership revoked if the third-party reseller breaks MAP. Negotiated Contracts: From time to time, it may be explicitly approved by N1o1 Pneuma Nitric Oxide LLC in writing to advertise certain N1o1 Pneuma Nitric Oxide LLC products below MAP pricing. The discount amount and length of time will be determined at the time of this approved promotion by N1o1 Pneuma Nitric Oxide LLC. N1o1 Pneuma Nitric Oxide LLC may run a sale from time to time and in such case the MAP will be the same as the sale price on those particular items and on those particular dates. N1o1 Pneuma Nitric Oxide LLC will send out a notice in advance with details of the special. N1o1 Pneuma Nitric Oxide LLC. will supply a copy of its MAP policy to authorized dealers. Third party resellers who purchase through authorized dealers are subject to this MAP policy. Resellers will be notified by email or in writing of any changes to MAP price or policy. Resellers will have one (1) week to institute pricing or policy changes. Intentional or repeated failure to abide by any of the above listed policies may result in termination of dealer/reseller or representative status LEGAL NOTICE: By purchasing Pneuma Nitric Oxide LLC products, the buyer agrees that the products are for personal use or use by the purchaser only and may not be resold, redistributed, or exported. Unauthorized resale or distribution may lead to legal action, including but not limited to injunctions, seizure of products, and damages. Pneuma Nitric Oxide LLC enforces its rights against unauthorized resale activities vigorously and will take legal action to protect its intellectual property to the fullest extent of the law. COPYRIGHT & TRADEMARK: All company brand names, and logos of Pneuma Nitric Oxide LLC are trademarks or registered trademarks of Pneuma Nitric Oxide LLC or its affiliates. Unauthorized use is strictly prohibited. By typing my full name in the box below, I certify that I have read and agree to the N1o1 Minimum Advertised Pricing Policy as described above.I Agree (type full name)(Required)Date(Required) MM slash DD slash YYYY I Have Read and Agree to the Minimum Advertised Pricing Policy I agree Medical LicenseThank you! Next please upload a copy of your active Medical License. As part of our standard procedure, we kindly request that you upload a copy of your current Medical license. This helps us ensure that all our partners operate within the necessary legal requirements. Please upload a clear, legible copy of your Medical license using the secure link provided below. If you encounter any difficulties or have any questions, feel free to reach out to us. We're here to assist you throughout the process.First Name(Required)Last Name(Required)Please upload your Current Medical License(Required) Drop files here or click to upload. Files are uploaded immediately. Drop files here or Select files Accepted file types: pdf, jpg, png, jpeg, gif, doc, docx, xlsx, Max. file size: 2 GB, Max. files: 2.