Become a Boogie® Retailer

Email address *

First Name *

Last Name *

Title (optional)

Store Name *

Federal Tax ID *

Resale Tax ID *

Website URL *

Phone *

Fax (optional)

Street Address Line 1 *

Street Address Line 2 (optional)

City *

State * Select an option…AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)

ZIP *

Specialty * Select oneBoutiquePharmacyGift StoreOther

Other Specialty *

Type of Retailer * Select oneBrick & MortarOnlineBoth

Number of Locations *

Retailers will not offer Boogie® brand products on any third-party websites (Amazon, eBay, etc.) *

A password will be sent to your email address when your account is approved.

Register