Wholesale Application Form
OWNER/PRINCIPAL CONTACT
*
First Name
Last Name
Business Name
*
BUYER/MANAGER
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Website URL
Business Model
*
Brick and Mortar
Ecommerce Website
Both Brick and Mortar and Ecommerce Website
BRICK AND MORTAR LOCATIONS
*
CURRENT MERCHANDISE ASSORTMENT
Jewellery
Gift
Apparel
Accessories
Home Goods
Stationery
YEARS IN BUSINESS
Business Number (or) TAX ID NUMBER AND STATE OF ISSUE
*
A copy of Reseller permit/ business number
*
Browse Files
Cancel
of
ADDITIONAL COMMENTS
Submit
Should be Empty: