Wholesale

WHOLESALE SIGN UP FORM.

Business Owner Info

First Name *

Last Name *

Business Phone *

Personal Cell

Email *

Business Info

Legal Business Name *

Operating Name *

Business Number *

No of Stores *

Expected Monthly Purchase

Online Store URL

Instagram Handle

Addresses

Billing address same as shipping

Business Licence

Business / Tax Licence *

Specialty Store Licence

Native Status Card (Front)

Native Status Card (Back)

Other Information

How did you hear about us?

Expected Monthly Spend

Signature of Business Owner / Authorized Representative

Full Name *

Date & Time Signed