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USERNAME & PASSWORD
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	Password*	(At least of 4 characters)
	Re-enter Password*
	Title*
	First Name*
	Last Name*
	Company
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	Name Of School For Current Students
	License #
BILLING ADDRESS
	Address*
	Address (line2)
	City*
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SHIPPING SAME AS BILLING
SHIPPING ADDRESS
	Address*
	Address (line2)
	City*
	State*
	Other State
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	Country
	Zip/Postal Code*	NO ZIP CODE
CONTACT INFORMATION
	Phone*
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		DISTRIBUTOR AGREEMENT
		I hereby confirm that I am a legally icensed beauty industry professional or current student, and that all purchases made by me or a representative of my company from this site, or from Grace Albert Aesthetics directly, are to be used in the process of delivering client services and/or resold to my clients. I understand that if my business is located in California and I do not wish to pay sales tax, that I am responsible to provide Grace Albert Aesthetics with a copy of my resale license or a resale certificate with the necessary information. Failure to provide GAA with my resale information will result in state and county taxes be applied to my order.
		I have read and agree to the Distributor Agreement