Wholesale Account Application

Fields with an (*) are required

Company Information

* Company name:

Address:*

Address:

City:*

State:*

Zip:*

Phone (toll-free for listing on website):*

Fax:

Web site:*

Company is: *

	Sole Proprietor / DBA
	Partnership
	Corporation
	Non-profit group or organization
	Other:

Main sources of business include:*

	Brick and mortar store
	Catalog sales
	Internet sales
	Other:

Year established:*

FORMS NEEDED:

You must fax, email, or snail mail a copy of the State Resale Certificate.
fax: 877-716-3988

1) State Resale Certificate

(Certificate #)

(State)

2) Federal Tax ID

Key Contacts & Billing Information

Name:

Email address:

Phone number(s):

Billing Address:

City:

State:

Zip:

Sales Information

Gross Sales Last Year:

Percent of Sales that are diaper products:

How many lines of diapers do you carry?

List other brands here:

How do you advertise?

How often do you update your website?

Shipping Information

* Company name:

* Address:

Address:

* City:

* State:

* Zip:

* Residential address?

Special instructions:

Wholesale Graphics and Forms

Wholesale Account Application

Company Information

Key Contacts & Billing Information

Sales Information

Shipping Information

We will contact you once we review your application.