Wholesale Customer Application
Apply to become a wholesale customer of Diemand Farm. **You must be approved as a new wholesale customer before you can place an order.
Business Name
*
Business Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Physical Address (if different than mailing address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
General Business Phone Number
*
-
Area Code
Phone Number
Contact Name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number (if different from General Business Phone Number)
-
Area Code
Phone Number
Preferred Method of Contact
*
Email
Phone
Days and Hours of Operation
*
Include hours available to accept deliveries if different from regular store hours.
Which products would you like to purchase? Choose all that apply. Items subject to availability.
*
Wholesale Soups
Wholesale Pot Pies
Wholesale Eggs
Wholesale Chicken
Wholesale Turkey
If you are accepted as a wholesale customer and are within our delivery area, there will be a $6.00 fee added to all deliveries. Note that deliveries are limited to a particular radius of our farm.
*
Prefer to pick up
Prefer delivery
Include any special requests or notes here:
If you are accepted as a wholesale customer and are within our delivery area, there will be a $6.00 fee added to all deliveries. Note that deliveries are limited to a particular radius of our farm.
Retail/Wholesale
Wholesale
Application
*
Application
Submit
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