Wholesale Application Form

Qualified businesses can purchase Lunapads, Lunapanties, and The DivaCup on a wholesale basis through our easy online wholesale ordering system.
Tell us about your business below and we will contact you shortly.

Please note that we are unable to supply The DivaCup to businesses outside of North America.
Contact international@divacup.com for information on the distributor nearest you.

Company Name *
Year Established *
Contact Name *
Email Address *
Telephone Number *
Website URL
US IRS # (US)
VAT # (Europe)
GST # (Canada)
Other International Tax ID #
Brick & Mortar or Online Store? *
What other brands do you carry?
Specialization of Business *
Where did you hear about Lunapads? *