Thank You For Your Interest In Becoming A Wholesale Dealer!

Thank You For Your Interest In Becoming A Southern Couture Retailer!
Southern Couture offers quality products, helpful customer service, fast ship times and territory protection.

In order to apply for a wholesale account please provide the requested information in the form below, along with a copy of your sales tax certificate and a picture of your storefront. You may upload the copies below or fax them to us at 1-318-368-8477. Please allow 5-7 business days for processing from submission of this form and required documents.

If you have any questions please call us at 800-575-5445 or email us at info@coutureteecompany.com
Company Name*
Contact Name*

First NameLast Name
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Physical Store Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Alt. Phone Number

Area Code Fax Number
E-mail*
Sales Tax ID Number*
Include Dashes
Website Address
E-mail
How did you hear about us?
Copy Of Sales Tax Certificate*

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Picture(s) of Store*

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