Emerald Energy® - Since 1992

Thank you for your interest in Emerald Energy®! To become a wholesale customer, please fill out the following form:

BUSINESS INFORMATION

Business Name
Street
City
State
Zip Code
Phone Number
Fax Number
Website Address
Email Address
Federal Tax ID (EIN/TIN)
Seller's Permit Number
State Where Issued
Number of Years in Business
Number of Years at Location
Description of Business

Accounts Payable Contact
Phone Number
Fax Number
Email

How did you hear about Emerald Energy®?
Why are you interested in becoming a wholesale customer?
What similar products do you currently sell?

PRINCIPLE STOCKHOLDERS OR OWNERS (TOP 4)

Name
Title
Street
State
Zip
Phone

Name
Title
Street
State
Zip
Phone

Name
Title
Street
State
Zip
Phone

Name
Title
Street
State
Zip
Phone

BANK REFERENCE (IF REQUESTING CREDIT TERMS)

Name of Financial Institution
Account Number
Address
City
State
Zip Code
Contact Person
Phone/Extension
Fax Number

TRADE REFERENCES (IF REQUESTING CREDIT TERMS)

Company Name
Contact Person
Phone Number
Fax Number
Street
City
State
Zip Code
Account Number

Company Name
Contact Person
Phone Number
Fax Number
Street
City
State
Zip Code
Account Number

Company Name
Contact Person
Phone Number
Fax Number
Street
City
State
Zip Code
Account Number

Company Name
Contact Person
Phone Number
Fax Number
Street
City
State
Zip Code
Account Number

ADDITIONAL NOTES OR COMMENTS

PERSON COMPLETING THIS FORM

Name
Title
Phone
Email
Date

CERTIFICATION
The information included in this wholesale and credit application is to be used to determine wholesale eligibility and the amount and conditions of credit, if any, to be extended. I understand that the other sources of credit considered necessary in making the determination may also be used. Further, I hereby authorize all references to release credit information regarding our company for application purposes.

I have read, understood, and agree to the Wholesale Policies.

I certify, under penalty of perjury, that all information provided above is true and correct.

QUESTIONS? Please contact us.

A Natural Multi-Vitamin. Premium Hawaiian Spirulina is the first ingredient in all of our formulas. Spirulina is a microscopic fresh water plant and one of the most nutritious foods on the planet. It’s a complete protein, contains all the essential amino acids, and is packed with vitamins and minerals, including 300% more calcium than milk, 2300% more iron than spinach, and 3900% more beta carotene than carrots.

Unsurpassed Formulas. Emerald Energy® was designed by health practitioners for clinical use. All the ingredients are balanced and harmonized according to the principles of Traditional Chinese Medicine for maximum benefit.

Sustained Energy. Our nutrient dense formulas provide lasting energy all day long without a "crash."

Best Ingredients. Emerald Energy® contains no synthetic ingredients, artificial colorings, sweeteners, preservatives, caffeine, or hydrogenated oils. Every ingredient is carefully tested for integrity, potency, heavy metals, pathogens, and other contaminants.

GMO Free. Emerald Energy® is made only with GMO-Free/Identity-Preserved soybean lecithin, an ingredient necessary for healthy brain function and protection against free radical oxidation.

Gently Made. Emerald Energy® is never blended using harsh machinery that can harm the natural enzymes through heat or processing.