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WHOLESALE APPLICATION

ALL INFORMATION PROVIDED WILL BE HELD IN STRICT CONFIDENCE. Fields with a star (*) are REQUIRED.

COMPANY INFORMATION
Company Name*
Address 1*
Address 2
City*
State*
Country*
Postal Code*
Website URL
Business Hours
Company Phone*
Company Fax*
Company Email*
Manager's Name*
Manager's Email*
Federal Tax ID #*
Reseller License #*
Owner Information
Name
Title
Phone
Please check one: Corporation
  Proprietorship
  Partnership
  Other (please specify)
 

 
GETTING TO KNOW YOU

Is your shop located in a: Mall   Shopping Center   Own Building   Other

Would you like to receive emails about new products and/or sales? Yes   No  

What is the specialty of your store? Maternity   Baby   Gift   Other  

Is your shop 100% INTERNET based? Yes   No
If "Yes", you must provide a live URL with an active store view under "Company Information" above!

TRADE REFERENCES
Company Name*
Address line 1*
Address line 2
Fax #*
Account #*
Company Name
Address line 1
Address line 2
Fax #
Account #



 

 

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