Wholesale application form

PLEASE CHECK ALL THAT APPLY: PLEASE CHECK ALL THAT APPLY: BRICK AND MORTAR* BRICK AND MORTAR AND ONLINE ONLINE ONLY BOUTIQUE (MINIMUM 1,500 FOLLOWERS ON FACEBOOK OR INSTAGRAM)

Store Name

Buyer

Address

City

State

Zip

Phone

Email Address

Instagram

# of Years in Business

Shipping Address (if different than above)

Shipping Address 2 (if different than above)

Shipping City

Shipping State

Shipping Zip

Primary Contact Name

Primary Contact Phone

Primary Contact Email

Tax ID/Reseller ID

Website

Have Crowned Sales Rep? If yes, please list name:

12 + 1 =

Please email your Resale Certificate and 2-3 photos of your store’s interior and exterior (for Brick and Mortar Applications) to [email protected]

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