Wholesale Registration Form

Wholesale Registration Form

Application & Agreement
Business Name:
Contact Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com
How did you hear about us?*
Please Specify*
Is your company tax exempt? (Must provide certificate)

YesNo
Federal ID# or SS#
Owner(s) or Officer(s) Information: (Name, Title, Home address)
Owner(s) or Officer(s) Information: (Name, Title, Home address)
Owner(s) or Officer(s) Information: (Name, Title, Home address)
REQUIREMENT: You must provide proof of qualifying business. This application is for a wholesale cash account, which entitles you to wholesale pricing. All information requested must be provided or application will be denied. Proof of business in qualifying category is required.
For proof of business, I've attached:
Choose one category that best describes your business:
Persons authorized to make purchases:
Should be Empty:

REQUIREMENT: You must provide proof of qualifying business. This application is for a wholesale cash account, which entitles you to wholesale pricing. All information requested must be provided or application will be denied. Proof of business in qualifying category is required.