B2B Account Intake

B2B Account Intake

Provide your details and upload necessary documents to create your account.
Representative Name*

First NameLast Name
Company Name*
Office Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Billing Email*
example@example.com
Billing Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Delivery Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Authorized Representatives *
Please list all individuals with their phone numbers and job title that are authorized to place orders on behalf of this account. "N/A" if none.
Upload Tax Exemption Document (if applicable)

Sales tax will be charged without exemption
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Upload Business License *

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Should be Empty: