Account Application

Account Application
Legal Business Name*
EIN #*
Name

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Resale Certificate Upload*

Cancelof
When you submit this form to us, we will confirm the business details with the documentation provided and then create your wholesale account. Once created, you will receive your username and password to your account. Upon first use, we recommend changing your password in order to protect your account.

Thank you for your interest!

The USMX Supply Team
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