WHOLESALE APPLICATION and UPDATE FORM

Wholesale Application & Update Form
Please supply all information or write N/A on the line
Company Name*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reseller License No.*
Required
FEDEX or UPS Account
If we are to use your account
Bill to Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Buyers Name

First NameLast Name
Buyer's Phone Number

Area CodePhone Number
Buyer's Email*
Email for Tracking*
AMEICO will e-invoice to the email address provided below unless otherwise instructed:
Email Address for Electronic Invoices*
example@example.com
A/P Contact Name*

First NameLast Name
A/P Contact Email*
example@example.com
A/P Phone*

Area CodePhone Number
A/P Fax

Area CodePhone Number
Instagram Handle
Canadian customers: Please supply your Customs Broker information here:
Should be Empty:

Wholesale Application & Update Form