Wholesale/Retail Dealer Application

First Name

Last Name

Tax ID

Business Name

Business Address

Business Email Address

Business Phone Number

Business Website Address

How did you hear about us?

Is there something else you want to let us know?

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Please fill out all required areas of the application.

If you are an International Retailer please enter zeros for your Tax ID.

All applications are pending approval. We aim to respond within 3 business days.

Safe Connect Plus Technology and Products work by creating a subtle energy field that carries vital information about health and wellness to positively impact and harmonize not only the Human Bio-field but also any damaging and chaotic fields of energy as a result of man made electromagnetic fields.

Dr. Mark Virkler

Wholesale/Retail Dealer Application

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