Wholesale Application

General Information

Company Name

Company Website

First Name

Last Name

Phone

Password

Password Strength: No Password

Confirm Password

Fax

Accounting Contact Name

Accounting Phone

Accounting Email

Address Information

Billing Address

Street Address

Address

City

State/Province

Zip/Postal Code

Country

Ship to this address

Shipping Address

Street Address

Address

City

State/Province

Zip/Postal Code

Country

Company Details

Do you currently sell online?

No Yes

If so, on what websites?

Business Type

State Resale Tax ID# (if applicable)

We are required by the IRS to get a Taxpayer Identification Number from you. Please fill your Employer Identification Number (EIN) below.

EIN

Tax Exemption Form

Download Tax Exemption Form

Under penalties of perjury, I certify that:

1. The number shown is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject o backup withholding. (You must cross out this item if you have been notified by the IRS that you are currently subject to backup witholding because of underreporting interest or dividends on your tax return.)

I agree to the above terms and conditions