Reseller Application

HeartMath® Products - Distribution Application

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If you are interested in becoming a distributor of our products please complete the following application. 
We will be in touch once we have processed the application.
Name




Address & Contact Information






Territories
List the Countries and Territories you currently distribute to

Please select the HeartMath® products you are interested in Distributing.
Product Range
Please list the Brands and Products you currently distribute, including any that are in the same category as our products.
How do you plan to market our products?
Distribution Model
Tell us about what channels and methods you plan to distribute our products. 
List any websites you might use to sell our product online.
Anticipated Market
Please let us know what product volumes you anticipate selling per month.

Trade References

Please provide contact name, phone and email addresses for three manufacturers you currently rep.

What would be the approximate size of your first order?

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Contact Information