Dealer Inquiries

The following expectations are designed to ensure that as a Back on Track Authorized Reseller, our partnership produces the necessary outcomes that we value in such partnerships. Passion, commitment, transparency, knowledge of the brand, adherence to our retail pricing policy, and an overall commitment and respect for the customers you serve.

Retailer Application (Brick & Mortar/Ecommerce)
Practitioner / Retailer Application
Practitioner Affiliate Program

Back on Track supports retailers representing a wide variety of establishments throughout North America. Brick and Mortar, Online Ecommerce, and Mobile units are the backbone to the industries we serve. Approval decisions are based on a number of factors.

Date(Required)

Legal Business Name(Required)

Billing Address(Required)

Street Address City State ZIP Code

Shipping Address(Required)

Street Address City State ZIP Code

Type of Business Entity(Required)

Phone(Required)

Website

Facebook

Owner Name or Name of Primary Principal(Required)

First Last

Contact Name(Required)

First Last

Position

Email(Required)

Phone

Extension

Hidden

Signature

Hidden

Is Physical Location Different?

Yes

Hidden

Fax

Store Type(Required)

Online

Brick and Mortar

Hidden

Website

Type of Business

Hidden

Brick and Mortar

Hidden

Chiropractor

Hidden

Therapist

Hidden

Other Business Type

Resale# / License# or Certificate#

Federal ID# (Tax# or EIN#)

Retail Stores: Please upload a copy of your Resale Tax Certificate when submitting your application.

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 100 MB.

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Doctors/Therapists: Please provide a copy of your Business License and Resale Tax Certificate to avoid sales tax.

Max. file size: 100 MB.

Trade Credit References

Company Name - Reference 1

Contact Name

First Last

Terms

Credit Limit

Hidden

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Hidden

Phone

Hidden

Fax

Company Name - Reference 2

Contact Name

First Last

Terms

Credit Limit

Hidden

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Hidden

Phone

Hidden

Fax

Company Name - Reference 3

Contact Name

First Last

Terms

Credit Limit

Hidden

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Hidden

Phone

Hidden

Fax

RETAIL PRICING POLICY

BACK ON TRACK is proud to be represented in quality retail outlets throughout the United States and is committed to providing excellent service and support to our retailers as well as top quality products to your customers. To maintain that level of quality and service, to encourage demand for our products, and to offer the opportunity for retailers to profit from sales, BACK ON TRACK believes that fair and reasonable pricing is necessary to both the retailer and to BACK ON TRACK.

It is therefore BACK ON TRACK’s policy that its products be advertised, offered, quoted, and/or priced at the minimum suggested retail price by all retailers. BACK ON TRACK will publish its minimum suggested retail prices annually. The minimum suggested retail price guidelines will be emailed to all retailers and will also be available on our wholesale website portal at www.wholesale.backontrackusa.com. Retailers are expected to comply with published prices immediately and to make any price adjustments within ten (10) business days from date of publication.

By virtue of placing orders and receiving shipments of Back on Track products, you agree to abide by our Retail Pricing Policy. Violation of this policy gives BACK ON TRACK the right to suspend further sale of products to your business at their sole discretion

I have read and will abide by the Back on Track Retail Pricing Policy. INITIALS OF AUTHORIZED PERSONNEL:(Required)

Signature(Required)

CAPTCHA

Back on Track supports the health care community through a network of Veterinarians, Medical Doctors, Chiropractors, Physical Therapists, Physiatrists, and others who provide professional health care services. In support of these important services, we offer a traditional Retailer Program allowing approved practitioners to stock product.

Legal Business Name(Required)

DBA

Practice Type(Required)

Billing Address(Required)

Street Address City State ZIP Code

Is Shipping Address Different?

Yes

Shipping Address(Required)

Street Address City State ZIP Code

Website

Phone(Required)

Federal ID# (Tax# or EIN#)(Required)

Contact Person

Contact Name(Required)

First Last

Position

Email(Required)

Phone(Required)

Extension

Please provide a copy of your Business License and Resale Tax Certificate

Accepted file types: pdf, png, jpg, jpeg, txt, doc, docx, Max. file size: 100 MB.

RETAIL PRICING POLICY BACK ON TRACK is proud to be represented in quality retail outlets throughout the United States and is committed to providing excellent service and support to our retailers as well as top quality products to your customers. To maintain that level of quality and service, to encourage demand for our products, and to offer the opportunity for retailers to profit from sales, BACK ON TRACK believes that fair and reasonable pricing is necessary to both the retailer and to BACK ON TRACK.It is therefore BACK ON TRACK’s policy that its products be advertised, offered, quoted, and/or priced at the minimum suggested retail price by all retailers. BACK ON TRACK will publish its minimum suggested retail prices annually. The minimum suggested retail price guidelines will be emailed to all retailers and will also be available on our wholesale website portal at www.wholesale.backontrackusa.com. Retailers are expected to comply with published prices immediately and to make any price adjustments within ten (10) business days from date of publication.By virtue of placing orders and receiving shipments of Back on Track products, you agree to abide by our Retail Pricing Policy. Violation of this policy gives BACK ON TRACK the right to suspend further sale of products to your business at their sole discretion

I have read and will abide by the Back on Track Retail Pricing Policy. INITIALS OF AUTHORIZED PERSONNEL:(Required)

Signature(Required)

CAPTCHA

Practitioner Affiliate Program providing non-stocking practitioners direct referral income when incorporated into their practice.

Become an Authorized Retailer

Type of Business

Trade Credit References

RETAIL PRICING POLICY

Contact Person