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		Groovy Goddess Authorized Reseller Application Sign up to become an Groovy Goddess Authorized Reseller today! Just fill in the information below and we will review your application and notify you of your approval status. (Asterisks indicate required information.) If you have any questions about this application, or the Program, please contact us at resale(at)groovygoddess(dot)com.   Download Printable Sign Up Form if you would rather mail or fax this form. First Name* Reseller # for tax purposes Last Name* SSN/EIN#* for tax purposes Company Name Website URL Address* Email Address* City* State* - select one -AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming Zip Code* Why do you want to be a Reseller? How do you plan to resell products?   How many Groovy Goddess products have you purchased?   I agree to the Terms and Conditions of the Groovy Goddess Reseller Program Submit   ©Groovy Goddess®, all rights reserved Home  |  Contact Us  |  Privacy Policy  |  Terms and Conditions