RETAIL APPLICATION

Wholesale Application

* Indicates required field

Business Name *

Contact Name *

First

Last

Business Address *

Line 1

Line 2

City

State

Zip Code

Country

Tax ID # *

Please submit a copy of your Resale Certificate *

Max file size: 20MB

Social Media Account links *

Tell us about your Boutique *

WHICH ARE YOU? *

BRICK AND MORTAR ONLINE ONLY POP-UP SHOP

Email *

Phone *

Business Website *

REFERRED BY *

How did you hear from us? *

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