Wholesale Retailer Application Form

First Name *

Last Name *

Store Name *

Email *

Position

WHAT YEAR WAS YOUR COMPANY ESTABLISHED?

Phone

Website

Company Instagram

SALES CHANNELS (CHECK ALL THAT APPLY) *

STREET ADDRESS LINE 1 *

STREET ADDRESS LINE 2

City *

State / Province *

Zip Code *

Country *

WHAT BEST DESCRIBES YOUR FOCUS?

NUMBER OF STORE LOCATIONS

WHAT OTHER BRANDS DO YOU CARRY? (UP TO SIX)

HOW DID YOU HEAR ABOUT US?