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Wholesales Retailer Application

Wholesale Retailers Application

Company Name

Type of Business / Business Structure (Sole Proprietorship, Partnership, Corporation

Address / City / State / Zip Code

Website

Primary Contact

Title

Phone Number / Fax Number

Federal Tax ID

Seller’s Permit Number (California)

Fulfillment Type (Ship to Warehouse or End User)

Signature / Date / Title

Message

Terms And Conditions

This application has been carefully read by the undersigned and is accurate and been completed to the best of your knowledge. By checking the box below the authorized signature has given permission on behalf of their company to verify the information listed above.

Terms And Conditions Checkbox

I Agree to the Terms and Conditions Statement