Open a new account – questionnaire If would like to become a CBD Dermaquest authorized reseller please fill out the below questionnaire and a sales representative will contact you.International inquiries, please contact info@dermaquestinc.com Twitter First Name Last Name Email Company Company Website Address line #1 Address line #2 (suite number) Zip City State/province Country Main phone number: How did you hear about us? (CHOOSE FROM DROPDOWN LIST) Please Select Esthetician Social Media Trade Magazine Trade Show Internet Already a stockist of Dermaquest Inc Other Industry: (CHOOSE FROM DROPDOWN LIST) Please Select Beauty salon Destination Spa Medi-spa Nail bar Role: (CHOOSE FROM DROPDOWN LIST) Please Select Skin care therapist Owner Manager Buyer Medical professional Which skin care lines do you currently carry? How many treatment rooms does your spa/clinic have? How many aestheticians would require training? What is your expected time frame to partner with CBD Dermaquest? What is your budget? (CHOOSE FROM DROPDOWN LIST) Please Select $500 - $1,000 $1, 000 - $1,500 $1, 500 - $2,000 $2,000 +