Wholesale Agreement Form

Please complete the following details to set up your wholesale account.

Business Information

Business Name

Enter the legal name of your business.

Business Address

Enter the registered business address.

Business City

Business State

Business ZIP Code

Ship to Address

Enter the address where orders should be shipped.

Ship to City

Ship to State

Ship to ZIP Code

Buyer Name

Enter the full name of the primary buyer contact.

Buyer Email

Enter the buyer's email address.

Buyer Phone

Enter the buyer's phone number.

Accounts Payable Name

Enter the name of the accounts payable contact.

Accounts Payable Email

Enter the accounts payable email address.

Accounts Payable Phone

Enter the accounts payable phone number.

Billing Street Address

Billing City

Ship to State

Billing ZIP Code

Signature

Please sign above to confirm agreement with Wholesale Terms and Conditions.