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Order Form

Lasamon Tethawat

© 2016 RapidLash.

Apply For A Wholesale Account

Not yet a RapidLash Wholesale customer and you would like to carry our products? Please complete the form below to create a wholesale account. A member of our team will review your on-line application and confirm with you as soon as possible.

Account and Billing Info:

Company name

Contact name

Phone

Address 1

Address 2

Address 3

City

State

Country

Zip Code

Same as Billing

Shipping Info:

Contact name

Phone

Address 1

Address 2

Address 3

City

State

Country

Zip Code

Email

Password

Anti-spam

Upload a copy of your tax id or retail certificate

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Please note that ROCASUBA, Inc does not allow our products to be sold on Amazon or E-Bay. For those customers interested in doing bulk quantity orders, please e-mail info@rocasuba.com.