Wholesale Application Form


If your website is currently being constructed, we will need template screenshots or a link to the beta version of your website.

Initial Method of Payment (Complete credit card information must accompany your first order)

For qualifying accounts, we offer Net 30 after the 1st prepaid order. Please provide the following information, accurately. Leave below blank if you choose to be charged upon shipping.

Vendor Contact Phone/Email

Due to a federal law, FR1633 which was effective July, 1, 2007, all mattress manufacturers are required to use a flame retardant (FR) in order to pass the required flame tests. This latest law has been put in place with the intention of helping to increase escape time for victims trapped in the event of a fire, which should save hundreds of lives each year. If you find others claiming that they make 100% organic or 100% natural mattresses without the use of an FR, please request details of how they are meeting the FR1633 law. There is a clause written into this law that permits the receipt of a flame retardant free mattress, should the customer have a prescription from an MD. A doctor's prescription must appear on a prescription pad. So long as we have the prescription, we can make you a Non‐Boric NO FR Green Cotton or 100% Organic Cotton mattress. You must send us your prescription via fax to 732‐828‐4159, or email it to sales@whitelotus.net, or post to 431 Raritan Ave, Highland Park, NJ 08904.

In accordance with federal law 1633, while they offer other natural options, White Lotus Home only sells 100% fire retardant free mattresses with a doctor’s prescription. As a client of White Lotus Home I will be responsible for getting a doctor’s prescription. This only applies to chemical free or organic mattresses WITHOUT a Fire Retardant or wool wrap.

IMPORTANT NOTICE: By signing below, you are agreeing to all the terms of this contract. ALL DECISION MAKERS IN YOUR BUSINESS SHOULD SIGN BELOW.