Business Name

Business Owner's Name

Business Phone Number

Business Email Address

Website/Social Media Links (if applicable

Business Address (or service area)

City, State

Zip Code

Business Type Business Type Beauty Supply Store Salon/Spa Independent Beauty Brand Boutique/Retail Store Other

If 'Other' is selected, enter it here

What types of beauty products do you sell? (Select all that apply) What types of beauty products do you sell? (Select all that apply) Haircare Products Skincare Products Makeup & Cosmetics Nail Care Products Fragrances Beauty Accessories Men's Grooming Products Other

If 'Other' was selected, enter it here

Do you currently sell products online? Do you currently sell products online? Yes No

If yes, where? If yes, where? Own Website Amazon Etsy Shoppify Other

If 'Other' is selected, enter it here

Average Monthly Sales Volume Average Monthly Sales Volume Under $5,000 $5,000 - $25,000 $25,000 - $100,000 Over $100,000

Do you have existing inventory for immediate fulfillment? Do you have existing inventory for immediate fulfillment? Yes No

How quickly can you fulfill orders? How quickly can you fulfill orders? Same Day 1-2 Days 3-5 Days More than 5 Days

Preferred Payment Method for Payouts Preferred Payment Method for Payouts Direct Deposit PayPal Business Bank Account

Are you open to offering same-day local delivery via LuxeDrivers? Are you open to offering same-day local delivery via LuxeDrivers? Yes No

Do you currently offer shipping? Do you currently offer shipping? Yes No

If Yes, what shipping providers do you use?

Electronic Signature

Date