Wholesaler Info
Upon application approval you will receive a wholesale coupon code to be used for online purchasing at time of checkout.
Type of Business
Campus Bookstore Specialty Shop Department Store Representative
Off Campus Store Gift Store Drug Store
Other:
Customer Information
Company Name:
Billing Address:
City/ State/ Zip:
Shipping Address:
Store Phone: Fax:
Email: Web site:
Number of Years in Business Tax ID #
Person to contact regarding purchase order and invoice payments:
Name: Phone Number:
Your Name: Title:
Date:
