Wholesale

Name *

First Name Last Name

Email *

example@example.com

Phone Number *

- Area Code Phone Number

Billing Address

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

Organization Name *

Organization Legal Name (if different from above)

Tax ID

Website

Years in business *

Organization Type

Instagram Handle:

Facebook:

Twitter:

Approximate Order Volume (monthly) *

units

Do you plan to sell online? *

Number of Locations *

Please list the addresses of up to 3 of your largest store locations below. If you have more than 3 locations, we'll will contact the primary contact asking for more info.

Store Location 1 Address

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

Display Photo

Browse Files

Upload photo of the area in your store where Mighty Patch will be sold for Location 1

Store 2 Address

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

Display Photo

Browse Files

Upload photo of the area in your store where Mighty Patch will be sold for Location 2

Store 3 Address

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

Display Photo

Browse Files

Upload photo of the area in your store where Mighty Patch will be sold for Location 3

How many addresses will you be shipping cartons of Mighty Patch to?

This may be less than the number of stores yo have if you use a third party logistics provider to sort/distribute/transload inventory.

Please list at least 3 other brands you currently carry:

Please describe a typical customer:

Wholesale

Primary Contact Info

Organization Info

Store Location Information

Brands and Customers