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Application for New Wholesale Partner

If you have any issues completing this form, please reach out to our Sales Team for assistance. 

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By submitting this application, I certify that all the information listed on this application is accurate and true to the best of my knowledge. In addition, I acknowledge and understand that the wholesale agreement is strictly offered to customers intended to resell Genie's Therapeutics products and abide by our Internet Minimum Advertised Pricing (IMAP) policy. I understand that Genie's Therapeutics reserves the right to reject this application or terminate it at any time. This application does not grant credit terms. A separate application form is available for this purpose.

By submitting this, I certify that all the information listed is accurate and true to the best of my knowledge. In addition, I acknowledge and understand that the wholesale agreement is strictly offered to customers intended to resell Genie’s Therapeutics products and abide by our Internet Minimum Advertised Pricing (IMAP) policy. I understand that Genie’s Therapeutics reserves the right to reject or terminate at any time. This application does not grant credit terms. A separate form is available for this purpose.