Wholesale Account Application & Account Agreement

All applications must be accompanied by a copy of the business resale certificate, seller’s permit, business license, and/or professional certificate. If information or requested supporting documents are missing your application will not be processed.

Business Name (include DBA if applicable) *

Value is required

Owner / Officer Name & Title *

Value is required

Primary Phone *

Value is required

Fax Number

License/Resale #

Number of Locations *

Value is required

Primary Email Contact *

Value is required

Website *

Value is required

Hours of Operation *

Value is required

Year Business Established *

Value is required

EIN *

Value is required

Annual Sales Volume

Annual Purchase Volume

Billing Address

Street *

Value is required

City *

Value is required

State *

Value is required

Zip *

Value is required

Shipping Address

Street *

Value is required

City *

Value is required

State *

Value is required

Zip *

Value is required

Description of Business *

Value is required

Type of Business (please check all that apply)

E-Commerce

Brick and Mortar

Chef

Restaurant/Café

Hotel

Department

Health Practitioner

Gym/Club

Spa

Other

Thank you!