Wholesale Product Order

Wholesale Vendor Application
Purchaser's Information
Contact Person Name

First NameLast Name
Company Name
Phone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the shipping information the same with the Purchaser's information above?

YesNo
Shipping Information
Person Name

First NameLast Name
Company Name
Phone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Resale Permit Number
Must email a copy of your permit
Type of business

internetbrick and mortarFundraiserwholesaler
year business opened

MonthDayYear
Date
Payment Method

Credit CardBank Transfer
Do you have any special instructions?
TERMS: The supply of Products to you is strictly for commercial or business use or resale. If you would like to talk to us about becoming one of our exclusive retailers or wholesalers, please contact us on the contact details given below.
Date Signed

MonthDayYear
Date
r3

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Toad Suck Mini Golf/Toxic Toad-Candy Division
502 HWY 64E., Conway, AR., 72032
972-322-4887 kim@toadsuckminigolf.com

www.toxictoadcandy.com
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Wholesale Vendor Application