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Wholesale Application

Please remember the email address and password you enter, as that information will be required to login as a wholesaler if your application is accepted.

* Indicates a required field.

* First Name: 
* Last Name: 
* Company: 
* Address: 

* City: 
* State: 
* Postal Code: 
* Email Address: 
* Fax: 
We will be emailing your activation notice to this email address.
Shipping Information
* Shipping Address is: 
Residential  Commercial 
Check here if Shipping Address is the same as Company Address above.
* Company: 
* Address: 

* State: 
* Postal Code: 
Business Information
* Class of Business: 
Proprietorship  Partnership  Corporation 
* Corporation Name: 
* State Resale Tax Number: 
New Owner: 
 Check if yes.
Purchase Date: 
Length of Time in Business:   year(s)
* Business Year: 
Seasonal  Year Round 
* Type of Business: 
Gourmet Food Store 
Department Store 
Gift Shop 
Account Information
* Term Requested: 
Credit Card  Net 15 
* Requested Password: