Wholesale Application

Company Name *

Owner Name *

Buyer Name *

Company Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Phone Number *

Website

Business Model *

Brick & Mortar

E-Commerce

Both

Brick & Mortar Locations

Current Merchandise Assortment (check all that apply) *

Lines Carried *

Number of Years in Business *

Tax ID Number and State of Issue *

Annual Sales *

How did you hear about us? *

Art Show

Etsy

Referral or Other