MODCOSMETICS | Retail Program Form

Shopping cart

0 Product(s) in cart

Total USD$0.00

> Checkout

Be the first to know about our specials and promotions. Join our newsletter

- Eyes
- Brushes
- Cases/Bags
- Makeup Kits
- All Products
- Browse Categorie

Retail Program Form

Before filling out the following application form Retail Program Information. Your request will be reviewed by our sales representative and you will be contacted with wholesale information within 5 business days. Submissions that do not meet our criteria will not get a response and will be deleted.

Thank you for your cooperation and kind understanding.

Your Company Name:
Tax ID Number:
License Number:
Type or Business:
For How Many Years:
Type of Customers:
Owners' Name:
Rep. Contact Name:
Email Address:
Phone Number:
Fax Number:
Business Address:
City:
Province/State:
Postal/Zip Code:
Country:
SUPPLIER REFERENCES (Makeup artists and aestheticians may write N/A if non available yet)
1st Supplier's Name:
Full Address:
Phone Number:
2nd Supplier's Name:
Full Address:
Phone Number:
I have read the Terms & Conditions:

Additional Information:

Please verify that your e-mail is
correct before submitting the contact form.

Welcome to our new website! We hope you will enjoy your stay and your comments are always welcome. We're having some great opening specials, don't miss them out! Thank you for your visit. Modcosmetics team.

Login Status

Not logged in

» Login

We supply make-up academies, beauty salons, highend SPA's and beauty supply stores as well as professionals in the beauty trade. Please click here for more info on our Retail Program.

home - products - faq - about us - links - contact