KOKUSAI DSP. Wholesale Application

KOKUSAI DSP. Wholesale Application
Company Name*
Buyer's Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Business Website*
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
What type of store do you have?*

Physical Retail StoreOnline StorePop-up ShopDistributorOthers, please specify below.
Others
Any comments
KOKUSAI DSP. does not authorize the sale of our 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
Should be Empty: