Madison + Green Wholesale Account Set Up Form

Wholesale Account Set Up Form
Company Name*
Buyer Name*
Buyer Email Address*
Buyer Phone Number*
Shipping Phone Number*
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Billing Email Address*
Billing Address (if different from shipping)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Resale#/Tax ID
Business Type (you may select more than one)

Brick-and-mortar retailSpa/Wellness studio backbar and/or retailHotel/Resort retailOnline retailOther
Website
Payment Term
Payment Method
Where did you hear about Madison + Green?
Notes/Comments
Should be Empty: