Professional Account Request Form

TiZO Professional Account Request 2024

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Business or name of practice*

Account Contact Name*

First Last

Website/Social Media Handles*

Professional Specialty*

Phone*

Email*

Fax

Business Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Shipping Address*

Street Address Address Line 2 City State ZIP Code

How did you hear about us?*

If "other" please describe…

Would you like to receive direct mail or emails about promotions and/or newsletters?*

Yes

Would you like to opt into TIZO Skincare Professional Locator?*

Yes

Promo Code:

Dispensing Practice Agreement (NOTE: you must check the box below)*

I agree to the Dispensing Practice Agreement

Fallien Cosmeceuticals, Ltd. dba Fallene, Ltd. (”Supplier”) manufactures and distributes U.S. Food and Drug Administration (FDA) regulated, over the counter (OTC) drug sunscreens and skincare products (”Products”) under the TIZO® and SOLAR PROTECTION FORMULA® trademarks (”Supplier’s Marks”). The Products are designed for sale through licensed medical and licensed aesthetic practices (”Account”) exclusively. As an official Dispensing Practice, you agree with the following terms:

Account agrees, represents and promises that all Products purchased from Supplier will be used exclusively for:

a.) Services performed on Account's premises

b.) Resale only to bona fide patients/clients on the Account premises in such limited quantities as necessary for personal and family use at home.

1.A.) and 1.B.) Collectively is referred to as “Account Use and Resale Restriction”. Account further represents and agrees that it will not resell Products to any other individual, business, retailer, practice, spa or re-distributor.

All Products delivered to Account are delivered in reliance on Account’s representation that they are solely for Account’s use and resale pursuant to the restrictions in Section 1 above. Any other use or resale in violation of the Account Use and Resale Restriction is prohibited and is considered to be “Diversion.” For each order that Account places with Supplier, Account reaffirms its representation that the Products are being ordered solely for Account’s use and resale in compliance with the Account Use and Resale Account may not use the Products for any purpose other than the Account Use and Resale Restriction without written consent from Supplier. If Supplier has any evidence indicating Account has diverted any Products, Account will be terminated without notice for diverting Products and will be subject to civil action.

Account is prohibited from selling Products or listing pricing electronically, Internet, Television, direct mail or

Account agrees that as an D.A. regulated OTC drug Product, it is required by law to contain one or more of the following: batch numbers, tracking codes, serial numbers and other codes as applied to all Products by Supplier. Account may not remove, alter, obliterate, or tamper with any batch numbers, tracking code, serial numbers or other codes applied to Product, box or pallet of Products and Account will not agree or conspire with others to do so.

Account represents that it currently meets, and during the duration of the term of the Agreement will continue to meet Supplier’s requirements to be an Account as stated above on the last page of this If Account changes its business operation and no longer meets Supplier’s requirements, as determined by Supplier, the Agreement shall automatically terminate without notice. Account agrees to promptly notify Supplier in writing, delivered by certified letter, of any change in Account ability to satisfy Supplier requirements to be an Account, or of any change in Account ability to comply with the Practice Use and Resale Restriction on all Products.

Account consents to the exclusive jurisdiction of the courts in Philadelphia, PA for all issues arising under this Agr The amount of damages that Fallene, Ltd. would suffer as a result of Diversion is extremely difficult to ascertain. Accordingly, Account agrees that equitable remedies should be granted to remedy any violation(s) of the Agreement. Account further agrees that “actual damages” for breach of this Agreement will be replaced by liquidated damages in the amount of three times the retail price of each Product that was diverted by Account. In any litigation arising from or related to this Agreement, the prevailing party shall recover its reasonable attorneys’ fees, whether the claims in the litigation are based in contract or tort law.

Account shall take appropriate steps to ensure that each of its employees and independent contractors are aware of the requirements of this Account waives any defense based upon the assertion or evidence that its employee(s), representative(s), or agent(s) were not aware of the requirements of this Contract/Agreement.

Either Supplier or Account may terminate this Agreement immediately by giving written Upon termination:
Supplier will immediately cease to sell Products directly or indirectly to

Account agrees to immediately cease sales of Products.
The Supplier and Account waive any claim for lost profits arising from the termination of this Agreement. This Agreement is not assignable by Account. The Agreement is specifically intended to benefit Fallene, Ltd. and may initiate suit to enforce the terms of this Agreement against Account.

During the course of the performance of this Agreement, the parties may disclose certain confidential information to the other solely to permit the other to perform its obligations under this Each party shall use its best effort to maintain the secrecy of all such confidential information. The parties shall refrain from using, disclosing, or otherwise exploiting any confidential information for any purpose not specifically authorized by the parties and consistent with this Agreement. All files, lists, records, documents, drawings, marketing and ad campaigns that incorporate or refer to any confidential information shall be returned or destroyed promptly upon termination of this Agreement. Confidential Information will only be disclosed to those employees of the parties that need such information to effectively perform their obligation to sell the Products.

This Agreement contains the entire understanding of Supplier and Account with respect to the subject matter hereof, and supersedes, revokes and cancels any and all other inducements, arrangements, understandings, agreements, representations or warranties, whether oral or written, between Supplier and Account in connection

This Agreement and the obligations of Supplier and Account hereunder may not be altered, amended or modified in any respect except by a writing duly executed by

In the event any provision of this Agreement is determined by a court of competent jurisdiction to be prohibited or unenforcable such provision shall be ineffective only to the extent of such prohibition or unenforceability, and such prohibition or unenforceability shall not invalidate the balance of such provision to the extent it is not prohibited or unenforceable, nor invalidate the other provisions hereof, all of which shall be liberally constructed to effect the intent of this

return policy

A REFUND/EXCHANGE FORM WITH AN INVOICE NUMBER MUST BE INCLUDED WITH ALL RETURNS.

Please call our office at 1·800 · 332 · 5536 or 610 · 630 · 6800 with any questions concerning our return policy. Fallene, Ltd. will issue authorizations for return of professional skin care products sold to wholesale accounts that meet the following criteria.

Products Eligible for Return:

Money Back Guarantee- All Fallene Ltd. products have a thirty (30) day unconditional money back guarantee (not including shipping and handling). Items may be returned within thirty days from date of purchase with a copy of the invoice or sales receipt issued at the time of purchase for a full refund or exchange (not including shipping and handling).

Damaged- Products received damaged may be returned for replacement within thirty (30) days of order date, including at no charge, shipping & handling. Please make these claims within 10 working days from receipt of products.

Received in Error- Product shipped in error may be returned unopened for credit, including shipping & handling, if requested by Please make these claims within 10 working days from receipt of products.

All products returned after 30 days from purchase will have a 20% restocking fee deducted from refund/exchange. There will be no refunds or exchanges issued after 60 days from purchase date.

Any product may be returned when patient is dissatisfied with the product’s performance. The account will be sent replacement product for the items returned.

All credit card purchases will be issued a refund to the credit card Purchases made with check will be refunded by company check.

Products Not Eligible for Return:

Product involved in fire, sacrifice or bankruptcy sale; or items that have been damaged due to conditions beyond the control of Fallene, Ltd., such as improper storage, heat, cold, water, smoke, fire and

Product that has been discontinued, without 60 days

Private Label products or Product that has been purchased at special

Product returned by a party other than the

Product that has passed its expiration

There will be no refunds or exchanges issued after sixty (60) days from purchase

Upload Professional License (Example: Physician, Esthetician..)*

Accepted file types: pdf, jpg, png, Max. file size: 20 MB.

Upload State Resale Certificate (Or Equivalent)*

Accepted file types: pdf, jpg, png, Max. file size: 20 MB.

A state resale certificate is the document used by your state that verifies we do not need to collect sales tax on your purchase. In some states this may be called a Certificate of Exemption, or you may use the Multistate Tax Commission (MTC) Uniform Sales & Use Tax Exemption Certificate or the Streamlined Sales Tax (SST) Exemption Certificate. If you are located in one of the following states, please upload a copy of you Business License instead: Alaska, Delaware, Oregon, Montana, New Hampshire.

By submitting this document you hereby have declared that you have read the term & conditions for resale and affirm that all of the information is accurate.