IN WITNESS WHEREOF, the parties have executed this Terms and Conditions For Sales of Bioprogramming Products on this day of

SALON INFORMATION

MAIN CONTACT

FULL NAME

TITLE

PHONE

Business Address

SALON/BUSINESS ADDRESS

CITY, STATE

ZIPCODE:

BUSINESS INFORMATION

ACCOUNT TYPE

SALON NAME

If you selected “Salon,” please enter your salon license information below. If you selected “Individual,” please provide your personal license details.

LICENSE NUMBER

ISSUED STATE

EXP. DATE

Please upload your resale certificate applicable in your jurisdiction. If you live in a jurisdiction which does not require a resale certificate, please indicate so by checking the below box.

I confirm that I live in a jurisdiction which does not require a resale certificate.

Applicable Beauty Salon Business License (Upload PDF/JPG/PNG)

Applicable Cosmetology License (Upload PDF/JPG/PNG):

I confirm that I have read the Salon T&Cs and understand that submission of this application does not guarantee account approval. I also understand and agree that once approved, Bioprogramming products may only be purchased from the Distributor listed on the signature page of the Salon T&Cs.