Contact Us: (507) 725-8883

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*

    CorporationPartnershipSole OwnershipOther


     

    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 - A*

    Address*

    City*

    State*

    ZIP Code*

    Phone*

    Fax

    Email

    Contact Person


     

    TRADE REFERENCES - B

    Company Name - B*

    Address*

    City*

    State*

    ZIP Code*

    Phone*

    Fax

    Email

    Contact Person


     

    TRADE REFERENCES - C

    Company Name - C*

    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.*


     
     

    SUBMISSION AUTHOR

    Name*

    Title*

    Additional Notes

    Lifestyle Medical Technology