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Become a retailer

If you are interested in becoming an authorized SmoothToe® and/or VO2fx® Energizing Socks retailer, please fill out the form below to the best of your knowledge and submit. All information provided is kept in the utmost confidence and will not be shared or used in any other way than for retailer account approval. We will review and respond to you within a reasonable time frame. Thank you for your interest in becoming a SmoothToe and/or VO2fx Energizing Socks retailer.

Our mission is clear ~ To make everyone feel and perform better.

Company Information

Company Name

DBA

Tax Id Number

D&B Number

Address

Street Address

City

State

ZIP Code

Phone

Fax

Email

Website

Type Of Business

In Business Since

Business Structure*

Corporation Partnership Sole Ownership Other

Officers

President

CFO

Vice President

Other - Please Specify

Accounts Payable Contact

Name

Title

Email

Phone

Fax

Financial Reference

Bank Name

Address

City

State

Zip Code

Contact Person

Email

Phone

Fax

Trade References - A

Company Name

Address

City

State

Zip Code

Phone

Fax

Email

Contact Person

Trade References - B

Company Name

Address

City

State

Zip Code

Phone

Fax

Email

Contact Person

Trade References - C

Company Name

Address

City

State

Zip Code

Phone

Fax

Email

Contact Person

SMOOTHTOE PAYMENT TERMS ARE NET 30 DAYS.

This company agrees to pay according to the term of net 30 days.

Please Remit Payments To:
Lifestyle Medical Group, LLC
Accounts Receivable Department
405 South Hwy 44/76
Caledonia, MN 55921

I understand that any delinquent amounts may render this application void and that I will then be placed on a cash-on-delivery (C.O.D.) basis, and all invoices will then become payable in full upon demand.

SMOOTHTOE PAYMENT TERMS ARE NET 30 DAYS.

Name

Title

Additional Notes