Home :: Wholesale

Wholesale Application

Business Information

Business Name

Owner's Full Name

Tax Exempt?

Yes

No

Resale Tax ID #

How long have you been in business?

Website URL

How did you hear about us?

Tradeshow

Social Media

Current Customer

Other

Store Address Line 1

Store Address Line 2

City

State/Province

Country

Zip/Postal Code

Type of Business

Type of business

Corporation

Partnership

Individual

LLC

What kind of Business is this? List any other locations.

Contact Information

Name

Title

Email Address

Telephone Number

Fax Number

Shipping Information

Shipping Contact

Phone Number

Email Address

Address Line 1

Address Line 2

City

State

Zip

Billing Information

Same as Shipping Information

Billing Contact

Phone Number

Email Address

Address Line 1

Address Line 2

City

State

Zip

List Three (3) Trade References

Reference 1

Name of Company/Contact

Phone Number

Email Address

Goods or Services Purchased

Reference 2

Name of Company/Contact

Phone Number

Email Address

Goods or Services Purchased

Reference 3

Name of Company/Contact

Phone Number

Email Address

Goods or Services Purchased