Natrol LLC and Jarrow Formulas, Inc. Chain Store Account Application for the United States

If you do not have an existing account with us, please do not submit this application.

Natrol Account Number(s) and/or Account Name(s)*

Jarrow Formulas Account Number(s) and/or Account Name(s)*

Is the new store a brick-and-mortar location or a new online storefront/website?*

Select all that apply.

Note, you must already be authorized by us in writing to sell our products online. If you are not currently authorized to sell our products online but wish to receive such authorization, please complete our Authorized Online Seller Application.

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Brick-and-mortar store

Online storefront or website

Requested Websites*

Please identify all websites or mobile applications through which you wish to sell Natrol and/or Jarrow Formulas products.

Exact spelling required.
For online marketplaces, include the Storefront Name and the Merchant ID.

Website Example: www.ABCStoreName.com

Online Marketplace Example: Amazon.com / “ABC Store” / Merchant ID

.

New Store Physical Address*

New Store Physical Address 2

New Store Physical City*

New Store Physical State*

Select

New Store Physical Zip Code*

Billing Address for New Store*

Billing Address 2

Billing City*

Billing State*

Select

Billing Zip Code*

Shipping Address for New Store*

Same as physical address

Same as billing address

Shipping address is different

New Store Shipping Address*

Shipping Address 2

Shipping City*

Shipping State*

Select

Shipping Zip Code*

Primary Contact Name*

Primary Contact's Title*

Telephone*

Phone

Fax

Phone

Primary Contact's Email*

EIN*

Example: 12-3456789

Do not provide a SSN. If you do not have an EIN, enter "None".

Resale Certificate Number*

Resale Certificate Issuing State*

Select

Accounts Payable Contact Person's Name*

Accounts Payable Contact Person's Title*

Accounts Payable Contact Person's Phone Number*

Accounts Payable Contact Person's Email Address*

Requested Payment Terms for New Store*

Same payment terms as existing account(s)

Prepay via credit card, ACH, or wire

Credit

COD

Additional Information

Include additional relevant information here.

Applicant Certification

By checking the boxes below and typing your name in the "Signature" section below, you agree to the terms set forth next to each of the following terms.

If you do not understand or accept or agree to the terms set forth below, then (1) do not check the boxes below, (2) do not submit this application, and (3) exit this site.

I certify that the information provided in this Application on behalf of the Applicant is true and accurate.*

I understand that submitting this Application does not authorize the Applicant to sell Natrol and/or Jarrow Formulas products (“Products”) on the Requested Websites or in the new brick-and-mortar store location, and that Natrol and/or Jarrow Formulas have no obligation to accept Applicant’s request to sell Products on any or all of the Requested Websites or in any new brick-and-mortar store location.*

Applicant's Signature

By typing your name in the "Signature" field below and clicking the "Submit" button at the bottom of this form, you are signing this Natrol and Jarrow Formulas, Inc. Chain Store Account Application electronically. You understand and agree that your electronic signature has the same legal force and effect as your manual signature on this application.

You also represent that you are authorized to sign this application form on behalf of the Applicant.

By checking this box and typing my name below, I am electronically signing this application.*

Signature*

Example:

/John Doe/

Legal Name*

Title*

Signature Date*

If you do not have an existing account with us, please do not submit this application.

Applicant Certification

Applicant's Signature

To receive a copy of your application, be sure to check "Send me a copy of my responses" below.