ROCKLAND BAKERY RETAIL WHOLESALE CUSTOMER APPLICATION
After your application has been reviewed you will be mailed a Wholesale Retail Card. This card must be shown to get the wholesale discount. Wholesale discounts are offered for bread items only. The discount card is to be used for business purposes ONLY. Rockland Bakery reserves the right to deactivate the card if fraudulent activity or inactivity is suspected. Replacement cards costs $10.00.
Customer Details:
Company Name
*
Tax ID Number
*
Full Name
*
First Name
Last Name
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
What breads are you interested in and what is your expected usage?
*
Are you requesting an additional card? ** There is a $10.00 fee per card. Once you get the notification your card has been processed, please pick up your card in our retail store with your $10.00 **
Yes
No
Signature
*
By signing I agree that all information provided is lawful & correct. I agree to the terms listed at the top of the page.
Submit
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