Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Authorized Seller Program Arcadia Consumer Healthcare Inc. has implemented an Authorized Seller Program for the United States to protect our brands, support our authorized sellers, and ensure an optimal experience for the end users who purchase our products. The Authorized Seller Program for the United States covers products sold under the following brands: Colace® Opti-Nail® Senokot® Authorized Sellers should review this page periodically as Arcadia Consumer Healthcare Inc. may update this brand list from time to time. Arcadia Consumer Healthcare Inc. Authorized Reseller Website Registration Form If you purchase Arcadia Consumer Healthcare Inc. (“Arcadia”) products from an Arcadia Authorized Distributor for purposes of resale to end-user consumers and wish to sell Arcadia products on your own proprietary website, you must register your website with Arcadia. Please note you are not authorized to sell Arcadia products on or through your own proprietary website until you have registered that website with Arcadia using this form. To complete registration, please review the Arcadia Consumer Healthcare Inc. Authorized Reseller Policy for the United States (“Authorized Reseller Policy”), including the attached Online Sales Guidelines, fill out the Arcadia Consumer Healthcare Inc. Authorized Reseller Website Registration Form (“Form”) below, agree to the Legal Agreement, and click SUBMIT. This Form is only used to register “Permissible Public Websites,” as defined in the Authorized Reseller Policy. The Authorized Reseller Policy prohibits you from selling Arcadia products on online marketplaces (such as Amazon, eBay, and Walmart Marketplace) without Arcadia’s prior written consent. Consent to sell Arcadia products on online marketplaces is not granted through this website registration process. This website registration process and the Authorized Reseller Policy are applicable only in the United States of America. * Fields marked with an asterisk are required. Company Information: Company’s Legal Name *Company’s DBA/Trade Names (if any) *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Phone *Entity Type *State of Incorporation/Organization * describe intend Name EIN/Tax ID *Primary Contact Person: Name *FirstLastAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *PhonePosition at Company *1. Do you sell or intend to sell Arcadia products at any brick-and-mortar locations? *YesNoPlease identify the physical address for each brick-and-mortar location where you sell or intend to sell Arcadia products. *2. Please identify the URL for each website where you intend to sell Arcadia products. *Please review the restrictions on online sales in the Authorized Reseller Policy carefully. Please note that you are only permitted to sell the Products on “Permissible Public Websites,” as defined in the Authorized Reseller Policy. Consent to sell Arcadia products on online marketplaces is not granted through this website registration process. 3. From which authorized distributor(s) do you purchase Arcadia products? *4. Do you store or intend to store your inventory of Arcadia products at a location other than the company address identified above? *YesNo Please provide the address for all locations where your inventory is stored or will be stored. *5. Do you intend to use any third-party fulfillment service (including drop-shipment by an authorized distributor) to fulfill orders for Arcadia products placed through the website(s) identified above? *YesNoPlease identify the name of the fulfillment service and describe the services provided. *Legal Agreement By checking the box below, I agree, on behalf of Reseller, as follows: Reseller acknowledges and agrees that it will abide by the Arcadia Consumer Healthcare Inc. Authorized Reseller Policy for the United States. Reseller understands that it is strictly prohibited from using Arcadia’s brands, names, logos, trademarks, service marks, trade dress, copyrights, and other intellectual property in any way other than as granted in the Authorized Reseller Policy without Arcadia’s express prior written consent. Reseller affirms that the information provided in this Form is true, accurate, and current. Click To Agree *Click to AgreeSubmit