Contact Information

Full Name *

This field is required

Company Name *

This field is required

Email Address *

This field is required

Phone Number *

This field is required

Business Information

Business Type *

Retail Store
Partnership
Corporation
LLC
Other

This field is required

EIN Number *

This field is required

Taxpayer ID *

This field is required

Do you list your products on any other platform?

Ebay

Own E-Commerce Website

Other Platforms

No I just sell on Amazon/Walmart

Billing Information

Billing Address *

This field is required

City *

This field is required

State *

This field is required

ZIP Code *

This field is required

Preferred Shipping Method *

Standard
Partnership
Expedited
Freigh

This field is required

Account Preferences

Interested Product Categories *

Electronics
Apparel
Home Goods
Beauty Products
Industrial Supplies
Other

This field is required

Preferred Payment Method *

Credit Card
Bank Transfer
Other

This field is required

How Did You Hear About Us? *

Referral
Online Search
Social Media
Trade Show
Other

This field is required

Additional Comments or Special Requirements *

This field is required

Terms & Conditions:

By applying for a wholesale account, you agree to our [Terms and Conditions] and [Privacy Policy]. Please review these documents before submitting your application.