Wholesale Submission Form

First Name ^*

Last Name ^*

Company Name^*

Website

Email^*

Phone^*

Address^*

City^*

State / Province^*

Postal Code^*

Country^*

Are you the primary decision maker?^*

YesNo

Type of Business^*

What is your average number of facials per day?^*

Do you currently have a licensed esthetician or skin care professional on staff?^*

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Would KPS Essentials be the only skincare line offered at your business?^*

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What type of services does your business offer?^*

How many facial rooms do you currently have?^*

How many years have you been in business?^*

Does your spa have a dedicated retail space?^*

YesNo

Number of locations?^*

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Phone: (616) 228-1055

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