Request Private Label Info

Materials (including prices) will only be sent to businesses associated with skin care. Please provide all required information below for review.

Business Name*
Full Name:*
Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Shipping Address (if different than business address - No PO Boxes)*
Same as business address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone*
Email*
Professional License #*

Students input "n/a"
Licensed State*
Professional License Upload*
Max. file size: 128 MB.
BiON only sells directly to actively licensed professionals. Please upload a current copy of your professional license for account verification and approval.
Optional - Logo Upload
Drop files here or

Accepted file types: pdf, ai, eps, svg, Max. file size: 128 MB.
Please upload a HIGH-RESOLUTION file of your logo.
How did you hear about BiON?*
What is the best way to contact you?*
Primary Business Type
Primary Job Title
Additional Comments