Primary Contact
*
First Name
Last Name
Business Name
*
E-mail
*
Would you like me to add you to the Counting Puddles wholesale newsletter to be notified first of new patterns being released for wholesale?
Yes please!
Not at this time
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Business Type:
*
Brick & Mortar
Online Retail
Brick & Mortar with an Online Store
Tax ID:
Resale Number or Tax ID
Website(s)
Social Media links
Is your shop located within the United States?
*
Please Select
Yes
No
Please provide your billing address:
*
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your shipping address the same as your billing address?
Please Select
Yes
No
Shipping Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please provide your shipping address:
Message (optional)
Submit
Should be Empty: