Wholesale Account Setup
Wholesale the finest elixirs, tonics & superherbs
Contact Information
Your direct contact information
Name
*
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Business Information
Company Name
*
legal company name
DBA
Type of Business
*
Website
*
Tax ID #:
*
Reseller Lic.#
please provide if you have one
Are you an Amazon re-seller?
*
provide storefront name below if different
Will you be selling online?
*
Yes
No
Provide further company information
*
we want to learn more about your business!
How did you hear about us?
*
Shipping & Billing Information
Street
*
City
*
State
*
Zip Code
*
Country
*
International Shipping Address
provide complete shipping information
Accounts Payable email
*
Accounts Payable Phone Number
*
Submit
Print Form
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