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Wholesale Application

Please remember the email address and password you enter, as that information will be required to login as a wholesaler if your application is accepted.

* Indicates a required field.

* First Name:
* Last Name: 
* Company: 
* Address: 

* City: 
* State: 
* Postal Code:
* Email Address:
* Fax:
We will be emailing your activation notice to this email address.
Shipping Information
* Shipping Address is:
Residential Commercial
Check here if Shipping Address is the same as Company Address above.
* Company:
* Address:

* State:
* Postal Code:
Business Information
* Class of Business:
Partnership Corporation
* Corporation Name:
* State Resale Tax Number:
New Owner: 
 Check if yes.
Purchase Date:
Length of Time in Business:   year(s)
* Business Year: 
Seasonal Year Round
* Type of Business: 
Gourmet Food Store
Department Store
Gift Shop
Account Information
* Requested Password: 

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