Modern Wax Seals Wholesale Account Setup Request Form

Wholesale Application

Please fill out all of the information below.

All fields with * next to them are required

Business/Store Name:

Contact Person

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

E-mail

State Resale Number

I Currently Have a Freund- Mayer Account:

My Business Is:

How did you hear about us?

New Accounts: Describe Your Business Activities:

Number of Years in Business

Products Interested In

We Would Like:

Additional Comments

I have read and agree to the Wholesale Terms And Conditions.