WHOLESALE REGISTRATION FORM
Currently open to Pharmacies and Retailers who wish to sell Bauer PPE
Type of Organization
*
School
Government
Seniors Residence
EMS
Pharmacy
Retailer
Other
Name
*
Mr.
Mrs.
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
*
Email
*
Confirmation Email
yourname@business.com
Phone Number
*
-
Area Code
Phone Number
Not-For-Profit Business Registration or Resale Certificate
*
Browse Files
Used to determine the ship-to state or province
Cancel
of
PST Exempt Number
*
For businesses residing in British Columbia, Saskatchewan, and Manitoba
Sales Representative Code
If Provided
Submit
Should be Empty: