Wholesale Application

Apply for InstaMed Wholesale Access.

Tell us about your business and how you plan to incorporate InstaMed products. Applications are reviewed individually before wholesale pricing and partner access are activated.

Business Information

Legal Business Name *

DBA

Website

Business Type *

Year Established

State *

Business Address *

Contact

Applicant Name *

Title

Business Email *

Phone *

Business Profile

Approximate Customer Base

Primary Market

Estimated Monthly Purchasing Volume

Expected First Order Volume

Current Products / Services

Program Direction

This helps us route your inquiry to the right program. It is not an approval or an offer.

Opening Volume

Brand Direction

Expected Order Frequency

Timeline

Territory / Region Served

Current Business Model

Interest

Select every area that applies to your business.

Wholesale InventoryDistributionSales OrganizationE-Commerce / Storefront

Other

Documents

PDF, PNG or JPG. Up to 8 MB per file. Documents are stored privately and reviewed only by our team.

Resale Certificate

Business License

Certification

I certify that I am applying on behalf of a legitimate business and that the information submitted is accurate.

InstaMedWholesale.com is operated by Blueprint Peak Performance LLC. No payment information is collected.

Proud To Be An

InstaMed Certified Provider

Authorized to source and supply InstaMed oral dissolving strip products through verified, tested and traceable supply.