DEALER APPLICATION

BECOME A STOCKIST

Interested in carrying our product? fill out our dealer application below and our team will get in touch with soon.

COMPANY INFORMATION

full legal name / business entity:

EIN:

BILLING Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

main point of contact:

Phone:

(###)

###

####

Email:

ACCOUNTING INFORMATION

Email for confirmations / invoices:

accounting contact name:

Accounting Contact Phone:

(###)

###

####

accounting contact Email:

social information

COMPANY INSTAGRAM:

COMPANY WEBSITE:

social media contact name:

social media contact phone:

social media contact email:

shipping information

Shipping Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

will you be arranging your own shipping?

select one

Yes

Preferred shipper:

ups account number: