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wholesale application

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* denotes required field

First Name*
Last Name*
Title
Store Name*
Federal Tax ID #*
Resale Tax ID #*
All new U.S. accounts must have a federal tax ID and Resale tax ID to open a new account. If you do not have one of the above, type N/A and explain why in the section below:
700 characters remaining
Email*
Website URL*
Phone*
Fax
Street Address*
City*
Zip Code*
State*
Type of Retailer*
Specialty*
Price Range of Merchandise *
Describe your store location. *
700 characters remaining
Clientele*
700 characters remaining
Size (sq ft)*
Other details*
500 characters remaining
Name 3 brands that you carry or plan to carry*
400 characters remaining
Is your store currently open? *
If yes, how many years has it been established?*
How many (brick & mortar) store locations do you have? *
How did you hear about us?*
Comments or questions
500 characters remaining
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