Company or Store Name:

Mailing Address:

City, State, Zip:

Shipping Address:  (Leave blank if same as mailing address.)

City, State, Zip:  (U.S. or Canada)

Buyer Name:

Store Telephone Number (s):

Fax Number:

E-mail Address:  (Required)

Website Address:



Resale Permit, Federal, or Tax ID Number: (Required)
We require a copy before your request can be processed.  You may fax your copy to 843-762-3490.

Type of Retail Store: (Select categories or use comments box below for details)

-- Select Category -- Antiques / Collectibles Artisan Center Distributor E-commerce Website Florist / Nursery Gift Shop (General) Gifts (Specialty) Museum Gift Shop New Age / Metaphysical New Business Natural Foods / Goods Nature Store Sales Representative Wholesaler Other (Use Comments Box)     -- Additional Category -- Antiques / Collectibles Artisan Center Distributor E-commerce Website Florist / Nursery Furnishings / Decor Furniture Gift Shop (General) Gifts (Specialty) Interior Design Museum Gift Shop New Age / Metaphysical Natural Goods New Business Sales Representative Wholesaler Other (Use Comments Box)

How long have you been in this business (check one) 

6 - 12 Months
1 -   2 Years
3 -   5 Years
5 - 10 Years
Over 10 Years

Does this business have a "physical" storefront?

Yes, I listed the location above.
Yes, we have a location but haven't opened yet.
Not at this time, we're thinking about it.
No, we retail through our website.
Other Method of Retailing (please specify)



Does this business have a website? (check one)
Yes, I listed the site address above.
Yes, it is under construction.
No, we don't have plans for a website.
Not at this time, we're thinking about it.


I am interested in the following product lines: (please check all that you are seriously considering for purchase)
Unscented Soap
Essential oil scented Soap
Fragrance oil scented Soap
Soap samplers (mini bars, travel size bars)
Goat Milk Soap

Lotions ( body lotions, lotion wands)
Linen & Body Spray
Face Care Products ( carrot cream, lip balms, facial wash, scrubs, etc)
Aromatherapy roll-ons (aromatherapy grade pure essential oils
Aroma roll-ons ( quality synthetic fragrance or essential oils + fragrance)
Soap balls
Soap samples ( only retail pricing applies for soap samples)

"Naked Soap" (No wrapping or label)
Bulk Soap Loaves
Pottery soap dishes ( wholesale pricing not offered on soap dishes)


I anticipate ordering frequency to be:

weekly
bimonthly
monthly
quarterly
occasionally

I anticipate ordering volume to be:
1-50 individual items
>50 but <100 items
>100 but <300 items
300-500 items
> 500 items

I would like to request the following: 

Please have a member of the Earth Maiden staff  contact me regarding placing an order.
Please rush - I am interested in placing an order this month.

How did you discover Earth Maiden Soap? 

Comments: