Business & Contact Information

Legal Business Name *

Doing Business As (DBA)

Business Type *

Medical Spa
Dermatology Office
Plastic Surgery Practice
Day Spa / Salon
Esthetician (Solo)
Online Retailer
Other:

First Name *

Last Name *

Street Address Line 1 *

Street Address Line 2

City *

State *

Zip Code *

Country *

Email *

Phone *

Website URL

Approved

Yes No

Licensing & Verification

How do you plan to use our products? *

Use in professional treatments only
Both retail & professional treatments

🔐 Professional-Use Only Accounts

These accounts are for licensed professionals who do not resell. You’ll have access to treatment-use and backbar products in limited quantities.

🔓 Reseller Accounts

Access retail and backbar products at wholesale pricing, with permission to resell in-store or online.

Professional License Number or NPI: *

This can be a cosmetology license, RN/MD license, or NPI if you’re a licensed provider.

State of Issuance: *

Upload your license, certificate, or professional ID: *

Choose file or drag here

Supported format: PDF, JPG, JPEG, PNG, GIF, SVG.

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Acceptable documents: esthetician/cosmetologist license, NPI certificate, RN/MD license, diploma, or business license.

Reseller Information

(Required for all accounts intending to resell FACTORFIVE products.
Please note: An EIN (Employer Identification Number) does not make your business tax-exempt in states that collect sales tax. A valid resale or exemption certificate is required for tax-exempt purchases.)

⚠️ Important Notice: Required Documentation

If you are located in a U.S. territory, list and upload the following:

Puerto Rico — The Merchant’s Registration Certificate from Hacienda includes a Merchant Registration Number (Número de Registro de Comerciante).
Guam — The Guam Business License includes a license number issued by the Department of Revenue & Taxation.
U.S. Virgin Islands — The Business License issued by the DLCA (Department of Licensing and Consumer Affairs) includes a license number.
American Samoa — The Business License from the Department of Commerce includes a license number tied to the business.
Northern Mariana Islands (CNMI) — The Business License issued by the Department of Finance includes a license number.

This documentation is required to verify your business status so we can correctly classify your account.

⚠️ Important Notice: Sales-Tax–Free State

Even if you are located in a state without state sales tax, you must still upload documentation that verifies you are a legitimate business. A state-issued resale permit is not always available in these states, so please provide one of the following in place of a traditional resale certificate/number:

Delaware — Business license issued by the Delaware Division of Revenue
Montana — Business registration/license from the Montana Secretary of State
New Hampshire — Business license or proof of registration from the NH Department of State
Oregon — Oregon Business Registry Certificate

This documentation is required to confirm your business status and allow us to correctly classify your account.

Business License / Registration Number: *

Enter your state resale certificate number or, if located in a tax-free state or U.S. territory, enter your business license or merchant registration number.

Issuing State: *

Upload Copy of Reseller Permit *

Choose file or drag here

Supported format: PDF, JPG, JPEG, PNG, GIF, SVG.

temp-for-103965-file2-3_

Upload a copy now, or email to us prior to your first order

Email Preferences

We’d love to keep you informed about new products, promotions, and important account updates. Please select the types of emails you’d like to receive from FACTORFIVE Skincare:

Yes, I want to receive communications from FACTORFIVE Skincare — including marketing emails with product launches, special offers, and educational content; sales representative updates with promotions and account support; and customer service notifications about order confirmations, shipping details, and policy changes.
No, I don't wish to be contacted

By checking yes, you agree to receive communications from FACTORFIVE Skincare and understand you can unsubscribe at any time.

Terms & Conditions

I agree to Wholesale Terms linked and noted below.

You can download the complete following terms and conditions here: Wholesale Agreement

FACTORFIVE™ CUSTOMER PROTECTION AGREEMENT

This Agreement is between the skincare professional ("CUSTOMER") and FACTORFIVE™. CUSTOMER shall, at all times, abide by FACTORFIVE’s™ Non-Diversion Internet Sales Policy as well as FACTORFIVE’s™ Minimum Advertised Pricing Policy ("MAP Pricing Policy") and shall not advertise any unauthorized price online nor supply FACTORFIVE™ products to any re-sellers or retailers.

THIS CUSTOMER PROTECTION AGREEMENT ("Agreement") is made as of this day by and between FACTORFIVE™ ("FACTORFIVE™"), a Delaware corporation, with its principal place of business located at 5941 Optical Court, San Jose, CA 95138; and the skincare professional ("CUSTOMER"), as defined by the skincare professional’s place of business with which the FACTORFIVE™ online account has been created.

In consideration of the mutual promises and covenants herein, FACTORFIVE™ and CUSTOMER ("Parties") do hereby agree as follows:

1. PURCHASE AND SUPPLY

a. FACTORFIVE™ will sell to CUSTOMER, and CUSTOMER shall, from time to time, purchase the Products from FACTORFIVE™. CUSTOMER will only sell or provide FACTORFIVE™ products to end users, and will not supply FACTORFIVE™ products to any re-sellers or retailers.

2. CUSTOMER’S QUALIFICATIONS

a. CUSTOMER shall be qualified and licensed as a skincare professional in the state(s) in which they practice and be certified or eligible in their specialty. CUSTOMER agrees to administer the Products strictly in accordance with FACTORFIVE’s™ directions, all applicable laws, and regulatory requirements.

3. NON-DIVERSION INTERNET SALES

a. CUSTOMER agrees to only sell, advertise, or reference FACTORFIVE™ pricing, images, trademarks, referral codes, and products on their own business website or brick-and-mortar location. Internet sales on any third-party platform (e.g., eBay, Amazon) are strictly forbidden.

b. CUSTOMER shall not advertise FACTORFIVE™ products using the internet (including search engines, social media, or online marketplaces), nor via print ads, mailers, or any other public advertising methods ("Advertisements").

c. CUSTOMER shall not purchase "FACTORFIVE™" or product names as Google AdWords™ or any online ad.

d. FACTORFIVE™ reserves the right to discontinue sales to CUSTOMER, with any outstanding amounts becoming immediately due.

e. FACTORFIVE™ may pursue statutory rights for trademark infringement and recover damages.

f. Approvals may be withdrawn at FACTORFIVE’s™ sole discretion.

4. MINIMUM ADVERTISED PRICING POLICY (MAP)

a. CUSTOMER must not advertise FACTORFIVE™ products below MAP, defined as 200% of wholesale pricing.

b. This policy applies worldwide to all customers and authorized resellers.

c. The list of MAP products may be updated by FACTORFIVE™.

d. The MAP policy applies to all media formats.

e. Online advertised prices, such as "Click for price" or auto-pricing emails, must comply with MAP.

f. In-office advertisements not distributed to clients are excluded.

g. Phrases like "call for price" or "lowest price" are allowed if no specific price is advertised.

h. FACTORFIVE™ may authorize temporary pricing exceptions and notify all resellers in advance.

5. MAP PRODUCTS

FACTORFIVE Shampoo Advanced Haircare
FACTORFIVE Post-Treatment Serum(s)
FACTORFIVE Regenerative Serum Mini
FACTORFIVE Anti-Aging Cream
FACTORFIVE Anti-Aging Cream Mini
FACTORFIVE Regenerative Serum
FACTORFIVE Regenerative Serum Mini
FACTORFIVE Eye/Lash Cream
FACTORFIVE Eye/Lash Cream Mini
FACTORFIVE Lash/Brow Growth Serum
FACTORFIVE Growth Factor Post-Treatment Facial Mask
FACTORFIVE Nourishing Silk
FACTORFIVE Nourishing Silk Mini
FACTORFIVE Night Retinol Cream
FACTORFIVE Gentle Gel Cleanser

6. TERMINATION AND LIQUIDATED DAMAGES

a. This Agreement may be terminated by either party at any time. Breach of this Agreement or associated policies results in immediate termination and liquidated damages of $100.00 per day per breach. This is in addition to any legal remedy or statutory damages.

7. ENFORCEABILITY, CHOICE OF LAW, VENUE, AND JURISDICTION

a. Non-enforcement of any terms does not waive future rights. Delaware law governs this Agreement. Prevailing parties in disputes may recover attorneys' fees and costs.

8. COUNTERPARTS & ELECTRONIC SIGNATURES

This Agreement may be executed in multiple counterparts and via electronic signatures under the E-Sign Act and UETA, which are legally binding.

ACKNOWLEDGMENT & AGREEMENT

THE UNDERSIGNED REPRESENTS AND AFFIRMS THAT THEY HAVE THE AUTHORITY TO BIND THE CUSTOMER AND/OR HAVE BEEN GIVEN PROPER AUTHORITY BY THE CUSTOMER TO SIGN THIS CUSTOMER PROTECTION AGREEMENT AND ENTER INTO THIS TRANSACTION.

BY SIGNING, I HEREBY:

Agree and consent to all provisions of the Customer Protection Agreement.
Specifically agree to fully comply with the Non-Diversion Internet Sales Policy and the Customer Minimum Advertised Pricing Policy.

International Inquiries

Thank you for your interest in working with FACTORFIVE! We partner with trusted distributors around the world to make it easier for professionals like you to order products, receive local support, and access special offers in your region.

Please go ahead and submit your application, and our team will either connect you directly with the distributor in your country (if one is available) or keep your information on file so we can reach out as soon as distribution becomes available in your area.

If you’d prefer to speak with someone directly, you can reach our team at sales@factorfiveskin.com.

Thank you for your submission!

Our team will review your information shortly. If you have any questions in the meantime, please reach out to us at accounts@factorfiveskin.com.

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