Resellers

Thank you for your interest in Radiant Life Company. To establish an account with us, please complete the following :
1. Fax your Resale or Business License to 707-433-8898
2. Submit the Application Form below

After your application has been processed (usually 2 business days) you will receive an email confirming your account and outlining the program.

Account Application Form
* Business Name:
Contact Name
* Email
* Phone
Mailing Address:
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Zip
Business Type	Practitioner Other
* Resale or Business License Number
* How did you hear about us?	WAPF Ad Website Friend Catalog Other
If Other, please specify