Smock Candy Wholesale Application

Smock Candy Wholesale Application
Contact Info*

First NameLast Name
Title*
Business Name*
Cell Number*
Business Number
E-mail*
example@example.com
Number of Locations*
Brick & MortarOnline Only
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Billing Same As Shipping?
State Resale Tax ID #*
As Shown On Your Tax Paperwork
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
2nd Location State Resale Tax ID #*
2nd Address*

Street Address

Street Address Line 2

CityState

Zip Code
3rd Location State Resale Tax ID #*
3rd Address*

Street Address

Street Address Line 2

CityState

Zip Code
State Resale Tax Certificate(s)*

*See Below For Examples.
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Upload Image(s) of Your Brick & Mortar Location(s)

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List Other Brands You Carry*
Social Media Links
Website URL
Please Tell Us About Your Business*
Terms and Conditions*
- Alabama
- Georgia
- Florida
- Louisiana
- Texas
- Kansas
- Mississippi
- Tennessee
- Should be Empty: