Wholesale Application Form

STORE INFORMATION

You will receive a confirmation once the application has been successfully submitted. Your account status will be communicated via email after review

Store Name & Address *

Store Name - Street, CIty, State, Zip

Phone number *

cell or landline

Email Address *

Will also be used as your login

Accept to receive notifications by email.

Tax ID / EIN *

**-***-****

Store Website

www.yourstore.com

Your Full Name *

First, Last

Your Position *

Owner

Manager

Buyer

Other

Made by PifyApp.

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Order products

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Order Total (The sum of all the prices of all the items in the order, taxes and discounts included.)

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Contact information

{Email}

{Phone}

Shipping address

{FirstName} {LastName} {Address1} {Address2} {City} {Country} {Prince} {PostalCode}

Billing address

{billingAddress-FirstName} {billingAddress-LastName} {billingAddress-Address1} {billingAddress-Address2} {billingAddress-City} {billingAddress-Country} {billingAddress-Prince} {billingAddress-PostalCode}
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Horseplay Apparel