Apply for a Wholesale Account

Use this form to apply for a wholesale account.

Customer Information

First Name Required

Last Name Required

Email Required

Address 1 Required Address 2 Required

City

Country Required

State/Province

Zip/Postal Code

Today's Date Required

Company Name Required

DBA / Fictitious Name Required

Company Structure Required

Website Required

Date company was founded / registered Required

Company FEIN or (Social if a sole proprietor) Required

Company Resale number / Sellers Permit Required

Name of Director Required

Director Phone Number Required

Director email Required

Tax ID/ABN/VAT Number Required

Company Billing Address Required

Company Shipping Address Required

Accounts Payable Contact Required

Accounts Payable phone number Required

Accounts Payable email address Required

Note Required

Please submit your filled out Uniform Resale Certificate & W-9 PDF here.

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