Active Minds, Inc. - Wholesale Purchase Qualification Form

In order to serve you more effectively, we have provided this form to validate qualified buyers so they can place their orders at wholesale rates.  Ordering minimum is set at one case, (4 pieces), per order. Upon approval, you will be sent an email with the URL, login information, and password to place an order at wholesale rates.

We respect your privacy and are committed to protecting it. Under no circumstances will the information you provide to us be disclosed to any third party. The information will only be used by Active Minds, Inc. to process your orders.