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First Name*

Last Name*

Customer Information

Sales Rep that referred you

Phone Number*

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Email*

Password*

Password Strength:

Passwords must be at least 8 characters.

Passwords must have at least one digit ('0'-'9').

Passwords must have at least one lowercase ('a'-'z').

Passwords must have at least one uppercase ('A'-'Z').

Confirm Password*

I have read the Authorized Reseller Agreement and accept it

I agree to not sell product to any distributors or wholesalers

I certify that I will not sell through unauthorized selling channels, as defined in this agreement, including Amazon, Walmart, eBay or any other marketplace

I have read the DM Merchandising Minimum Advertised Price Policy and agree to follow the conditions and requirements outlined

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