Wholesale Application Form

Dealer Application

Upon approval, you will recieve a notification email and instructions on setting up your account.

First Name *

Last Name *

Email *

Accept to receive notifications by email.

Phone *

Company Name *

How many years in business? *

Website

Company Address - Shipping

First name

Last name *

Company

Full address *

Apartment, suite, etc. (optional)

City *

Country/Region *

Province/State/Region *

Postal code *

Company EIN *

How Many States Are you TAX Exempt?

Please confirm so we can configure your account to not pay taxes at checkout

Business Type *

Retail Store

Online Store

Both Retail & Online

Other

If you chose retail, how many stores do you have?

If Other, please provide us with more information

Please tell us about your business *

Please Attach your tax exempt cert(s)

The max file size is 10MB.

Please upload a file before submitting.

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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

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Shipping address

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Billing address

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