Company Name
*
Name
*
First Name
Last Name
Contact Info
*
Phone
Email
Website/ Social Media
Website
IG/Social Media
How did you hear about Acaia?
*
Please Select
Event/ Tradeshow
Online/Web
Gift
Friend/ Referral
Other
Business Type
*
Please Select
B2B
B2C
Both
Will you be reselling?
*
In-store brick and mortar
Online w/ inventory
Online dropship
Internal use only
Other
Is your company based in the U.S.?
*
Yes
No
If not based in the U.S., do you have a U.S. forwarding address?
Yes
No
Please Provide a Shipping or U.S. Forwarding Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Tell us more about your company. How do you plan to use or resell Acaia products?
Acaia does not authorize the sale of Acaia products to third party websites such as Amazon, eBay, etc. I understand that selling to a third party website or unauthorized retailer will result in termination of wholesale account privileges
*
I understand
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