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