Wholesale Account Application Form

Wholesale Application Form

(for use of wholesale items only)
Business Name*
Phone:*

Area CodePhone Number
FEIN# *
if a sole proprietor please use LAST 4 of social.
Sales Tax ID#*
sole proprietor input (0)
E-mail:*
Website:*
Shipping Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
In Business Since

MonthDayYear
Type of Business*

InternetBricks and mortarWholesaleOther
Where do you advertise(select all that apply)

WebsiteFacebook Personal PageInstagramFacebook Business Page/GroupOther
Do you plan to drop-ship?

YESNO
Business Representative Information
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Message

0/500
Should be Empty:

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Wholesale Application Form