Wholesale Request
Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Retail Store Address If you have more than one location please list the top selling one here and we will collect the addresses for all of your location during the onboarding process.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Sales Volume
*
$0 - $5000/month
$5001 - $10,000/month
$10,001+ month
Which of our products are you most interested in carrying?
*
File Upload
*
Browse Files
Drag and drop files here
Choose a file
Upload a copy of your retail sales tax permit. We must have this before your membership will be activated.
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of
Submit Form
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