Adam and Eve Wholesale Register Now

WHOLESALE CUSTOMER ACCOUNT REGISTRATION FORM
COMPANY INFORMATION
Legal Company Name
Company DBA Name
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Type of business: select all that apply
Please select which account type you are interested in
Store Phone Number

Country CodeArea CodePhone Number
Website
Years in Business
For online sellers - where do you sell? List all sites
Do you collect and remit sales tax?
Tax ID
Copy of your state tax certificate

Cancelof
UNIFORM SALES & USE TAX EXEMPTION
I certify that if any property or service so purchased tax free is used or consumed as to make it subject to a Sales or Use Tax we will pay the tax due directly to the proper taxing authority when state law so provides or inform the Seller for added tax billing. This acknowledgement shall be a part of each order that we may hereafter give to you, unless otherwise specified, and shall be valid until canceled by us in writing or revoked by thee city or state. Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter.
OWNER INFORMATION
Owner's Name

First NameLast Name
Owner's Email
example@example.com
Owner's Phone Number

Area CodePhone Number
Country Code
Is the Owner also the Buyer?
Is the Owner also the Accounting Contact?
BUYER INFORMATION
Buyer Name

First NameLast Name
Buyer Email
example@example.com
Buyer Phone Number

Area CodePhone Number
Country Code
Vendors you buy from
ACCOUNTING CONTACT'S INFORMATION
Accounting Contact Name

First NameLast Name
Accounting Contact Email
example@example.com
Accounting Contact Phone Number

Area CodePhone Number
Country Code
TERMS OF SALE
I acknowledge and accept Nalpac/Entrenue terms and conditions found at https://www.nalpac.com/pages/nalpac-terms-of-sale
MAP AGREEMENTS
Please review Manufacturer MAP agreements here: https://www.nalpac.com/pages/map-agreements
I acknowledge that I have a read and understand the Manufacturer MAP Agreements provided to me at this link, above

WHOLESALE CUSTOMER ACCOUNT REGISTRATION FORM

COMPANY INFORMATION

UNIFORM SALES & USE TAX EXEMPTION

OWNER INFORMATION

BUYER INFORMATION

ACCOUNTING CONTACT'S INFORMATION

TERMS OF SALE

MAP AGREEMENTS