Retailer Application
Thank you for your interest in Caloosa! Please fill out the form below to apply to become one of our retailers.
Name
*
First Name
Last Name
Email
*
example@example.com
Name of Retail Store
*
Resale Tax ID Number
*
What type of storefront do you have?
*
Please Select
Online
Brick and Mortar
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Instagram Handle:
Facebook Handle:
How did you hear about us?
*
Social Media
Trade Show
Seaside Retailer Magazine
Email
Friend/ Recommendation
Other
Please verify that you are human
*
Submit
Should be Empty: