Wholesale Account Application
Date
-
Month
-
Day
Year
Date
Client/Account Information
Business Legal Name
*
DBA / Store Name
Type of Business
*
Please Select
Convenience Store
Gas Station
Smoke Shop
Vape Shop
Dispensary
Grocery Store
Liquor Store
Restaurant / Food Service
Hotel / Travel Center
Wholesale / Distributor
Online Retailer
Other (Please Specify)
If Other (Please Specify)
*
Type of Entity
*
Please Select
Corporation
Limited Liability Company (LLC)
Partnership
Sole Proprietorship
Other (Please Specify)
If Other (Please Specify)
*
EIN Number
*
Your information is secure and used only for business account verification.
Business E-mail address
*
example@example.com
Business Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Website / Social Media
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Next
Owner/Officer Contact Information
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail address
*
example@example.com
Would you like to add an authorized purchaser to this account?
Yes
No
Authorized Purchaser Full Name
*
First Name
Last Name
Job Title / Role
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail address
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Billing Address
Same as above
Contact Person
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shipping Address
Same as above
Contact Person
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Sales Tax Permit
*
Browse Files
Drag and drop files here
Choose a file
Your information is secure and used only for business account verification.
Cancel
of
Driver/State Issued License
*
Browse Files
Drag and drop files here
Choose a file
Your information is secure and used only for business account verification.
Cancel
of
Additional Information
Specific Registration Requests/Details
How did you hear about Sooner Distributors?
*
Please Select
Referral from another store owner
Sales representative / driver
Instagram
Facebook
Google search
Google Maps
Website
Walk-in / saw the building
Event / promotion / giveaway
Vendor or brand recommendation
Other (please specify)
If Other (please specify)
*
Who referred you to us? (Sales Representative or Driver)
Which vendor referred you?
Store owner who referred you:
Would you like to receive our monthly e-mail?
Yes
No
Apply for Wholesale Account
Should be Empty: